Insurance Advanced — Practitioner & Underwriting

Material non-disclosure is the failure to disclose any fact that, if known to the insurer at the time of underwriting, would have caused it to either decline the risk, charge a higher premium, or apply specific exclusions. Pre-existing diabetes, prior hospitalisations, chronic medications, smoking status, hazardous hobbies (paragliding, motorsport) and certain occupations are classic material facts. The insurer must prove materiality and the non-disclosure in writing — the proposer is not penalised for innocent omission of trivia.

After the insurer's written repudiation, the claimant first approaches the insurer's grievance redressal officer. If unresolved within 30 days or if the response is unsatisfactory, the claimant files a complaint with the Insurance Ombudsman of the relevant jurisdiction within one year of the repudiation, in the prescribed Form P-II. The Ombudsman conducts a quasi-judicial proceeding and can issue awards up to ₹50 lakh that are binding on the insurer (the claimant retains the right to approach civil courts if dissatisfied). The process is free of cost for the claimant and is generally completed within three to six months.

This is financial underwriting. The principle of indemnity (and the doctrine of insurable interest) requires that the sum assured be calibrated to the proposer's economic value. A 30-year-old earning ₹6 lakh per annum applying for ₹5 crore cover would fail this test — the insurer suspects either over-insurance (encouraging moral hazard) or fraud. Income proof allows the underwriter to apply standard multiples (typically 15-25x annual income at younger ages, tapering with age) and reject or scale down disproportionate covers.

Section 45 deals with the insurer's ability to question a policy. Suicide is governed separately under standard policy terms — most modern term policies contain a suicide exclusion only in the first 12 months from inception or revival, after which suicide is fully covered. The post-2015 Section 45 amendment further reinforces the policyholder's position by barring rescission after three years on any ground. Together, the framework protects the family in the vast majority of unfortunate cases.

It applies to the aggregate annual premium across all ULIPs of the same individual, as introduced by the Finance Act 2021 and codified through Section 10(10D) provisos. Holding multiple ULIPs each below ₹2.5 lakh but together exceeding the threshold also breaches the cap and the maturity proceeds become taxable as capital gains. The death benefit remains tax-free under Section 10(10D) regardless.

Reversionary bonuses, once declared, attach to the policy and become guaranteed payable on death or maturity — they cannot be revoked. Terminal bonuses are declared at the discretion of the insurer's board on a year-by-year basis and are not guaranteed in advance; they reflect the insurer's assessment of the participating fund's surplus at that point. A practitioner should set client expectations accordingly: illustrated bonuses in the benefit illustration are projections, not promises.

Three honest cases: (1) policyholders with chronic indiscipline who will not maintain SIPs voluntarily outside a forced wrapper — the inferior outcome inside a ULIP still beats no investment at all; (2) very long horizons (25+ years) combined with active equity-to-debt switching as the goal nears, leveraging tax-free intra-policy switching; (3) specific bundled-need scenarios for HNIs where insurance-trust structures and creditor-protection benefits combine with the investment outcome. In all three, full disclosure of charges and a side-by-side comparison with the separate construction is the practitioner's duty.

No. The MWP Act election must be made at the time of policy inception by signing the prescribed addendum or selecting the MWP option on the proposal form. It cannot be added to an existing policy retrospectively. For practitioners, this means MWP planning has to happen at the buying stage — a missed election cannot be cured later, even by endorsement.