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Are You New to Buying a RIB or Buying RIB Insurance?

Are You New to Buying a RIB or Buying RIB Insurance?


Thinking of buying a Rigid Inflatable Boat (RIB)? Well assuming it's for private and pleasure (P&P) use (commercial use will be dealt with in a separate article) here's a guide to some of the insurance issues you may encounter as well as some of the benefits you might get as part of your cover.

Use an Insurance Broker!


I'm going to say specialist insurance broker rather than a quotation sourced direct from an insurer. I will declare an interest here in that I actually am a specialist broker. There are advantages:

A specialist broker can do your shopping for you because they will have access to multiple markets and therefore make a recommendation as to which one best fits your needs.

A specialist broker should also be able to help you if a claim happens. Understanding and liaising with your insurers regarding liability and/or settlement value. They may also have access to a wide range of approved boat builders, dealers and repairers that will help you get your RIB back in use with minimum disruption to your pleasure in using your RIB.

This is in contrast to going direct to an insurance company which means you will just receive information based on their product. It also means you will have to make time consuming multiple telephone calls find out what is available so to decide what is best for you. That's OK if you have time, but time is money!

What Value is the RIB insured for - Purchase Price or Agreed Value?


You need to understand the basis on which your RIB is covered. It is common for insurers to cover the RIB and its equipment for the purchase price. However, cover can also be on "agreed value". If you are unsure which yours is check your insurer's policy wording. Some may state that they will pay the value stated in in the Schedule of Cover (this will be "agreed value") and others will state they will only pay up to that value (i.e. the purchase price less any depreciation). If your RIB is a total loss the difference in the policy wording could have a significant effect on the amount of your claim is settled for.

As you will expect, the more you pay for your RIB, the more your insurance cover is likely to cost. Insurers rate your policy on the value of your hull, machinery, trailer and any special equipment you might have. The rate applied will usually decrease as the insured value slides up, so the cost to cover a RIB at £50,000 would usually be proportionately cheaper to cover than one valued at under £10,000. 
Here are some of the other factors that will affect your overall annual premium for your RIB insurance:

Where are you keeping your RIB?


Location can matter. Certain parts of the UK that are considered prone to extreme weather and it will cost more to insure there. Additionally, your choice of mooring can have an effect too - chances are you could be relatively free from a moorings loading if you are on a pontoon in a marina but a swing mooring will often result in your cover costing you more. Also it is worth mentioning that, if your RIB is permanently moored in Continental Europe it will be rated differently than if UK based.

How Fast Can Your RIB Go?


There's no doubt that the last few years have seen an increase in performance of RIBs being used for P&P and the maximum speed of your craft will be a factor on your premium and the availability of cover.

Generally, up to 35 Knots is within the appetite of insurers. Above 35 Knots things start to change, with premium increased but most RIB insurers are comfortable offering cover up to 55 Knots. Above 55 Knots many insurers are uncomfortable meaning that they won't provide cover or there is a sharp rise in premium rates for these RIB's.

What is your experience on RIB's?


Some insurers will allow a small premium discount if you are an experienced skipper. By experienced this is usually taken to mean more than 5 years with RIB's. If you have less than 5 years' experience then be prepared to have your premium loaded - over 2 years' experience but under 5 would typically attract a load of 5% to the basic premium. Under 2 years and it could start to get painful; under 1 and you start to find insurers who will not even offer a quotation and others who will - but with a significant premium increase.

You're Qualifications?


The Royal Yachting Association (RYA) has recognised training centres worldwide. If you invest in getting appropriate RYA qualifications - such as Powerboat Levels 1&2 - there may be a premium discount.

No Claims have occurred?


Typically, insurers will allow a 5% discount per year up to a maximum of 5 if you have held boat insurance and made no claims but it is possible to find insurers offering larger discounts in certain circumstances.

Covering Personal Possessions & Accessories


Trailers, inflatables and other accessories used with your RIB can be added to your schedule of cover - there will usually be an additional premium charged. Check your policy documentation for terms and conditions relating to use, security and storage of these items.

In return for a further additional premium your insurers may allow you to add cover for personal possessions against loss of damage whilst on board your RIB. Before opting for this extension, however, it is worth checking exactly what is and isn't covered as some policy wordings will detail a lengthy list of excluded property, including (but not limited to) passports, money, credit cards, travel tickets, jewellery, watches keys, mobile phones and laptops. You might also be able to obtain a better premium rate and scope of cover for this type of property as an "All Risks" extension to your home contents insurance policy.

European Vacation?


Many providers will include up to 30-days European use (including road transit) as a free extension so you can hook up your trailer and have fun - don't forget to check your certificate and/or schedule to make sure this cover is in place before you go.

Here's a tip: If you are going overseas ask your insurer to provide you with a certificate in the language of the country where you will be using your RIB - it may save you a lot of hassle with the local authorities if you can present a certificate of cover that the local authorities don't have to get translated.

Transiting Your RIB


Cover for road transit of your RIB can be included on your policy - sometimes this is a freebie but some insurers will levy an additional premium for transit cover - don't forget to ask your broker if your transit cover is free or if they are charging for the extension.

Marine Third Party Liability


Your RIB's Marine Third Party Liability Insurance covers your legal liabilities arising from the use of your RIB as agreed by your insurers. It will cover injury to passengers and other third parties as well as damage to third party property.

This cover often comes as a free extension to your RIB's Hull & Machinery Insurance but some providers will levy a separate premium for your Liability Insurance. At time of publication the indemnity limit commonly provided by insurers is £3,000,000, though some will provide a higher limit if required (eg. a particular marina insists on a higher limit) in return for an additional premium.

Depending on where your RIB is berthed, it may be a requirement for you to have Marine Third Party Liability Insurance. For example, the Environment Agency (EA) requires all vessels on their waterways to be registered and part of the registration process is to provide details of your insurance. Although you are not required to submit your documentation the EA carries out spot checks and will fine boat owners who do not have the correct level of insurance.

Will You Be Water-skiing or Towing Toys?

Obviously you'll want to have fun with your RIB and if that includes water skiing or towing toys such as bananas, ringos and other inflatables you will need to have your liability insurance extended to include this activity.

Policies are commonly endorsed with the permitted number of toys or skiers that can be towed at any one time and may have additional conditions applied such as having somebody on board to act as a look-out or observer in addition to the helmsman.

Some Small Print to Look For:


High Speed Clauses

If the maximum speed of your RIB is in excess of 17 Knots then your insurers are likely to apply some additional terms and conditions to your cover.

Commonly defined as a "High Speed Clause" you are likely to find an endorsement on your schedule or certificate of cover that excludes cover that your policy usually provides to vessels with a design speed up to 17 Knots.

Each insurer will have a slightly different wording so it is worth studying this exclusion if it is likely to apply to you. If in doubt, speak to a specialist broker who is familiar with the nuances of different policies and is able to make a suitable recommendation to meet your specific requirements.

Outboard Locks


Theft of outboard engines is prevalent. Professional gangs seem to be able to operate without fear of being caught and some cases, such as where they have succeeded in removing even the largest engines from vessels in marinas, their success in escaping with tens of thousands of pounds worth of outboard has been extraordinary.

Insurers will almost certainly require your outboard engines to be secured to your RIB with an anti-theft device in addition to its normal method of attachment.

Wheel Clamps


Theft of your vessel while left unattended at any time on a trailer will more than likely be excluded unless it is secured by a wheel clamp. Some insurers will relax this if the trailer is in a locked building or compound. Check your documentation to be absolutely sure what your insurer's requirements are.

Excesses


Excesses often vary - usually the higher the value of your RIB and outboard, the higher the excess is likely to be. In addition to the standard excess, insurers may apply higher excesses for particular types of claim. For example, claims resulting from damage to semi-submerged objects (SSOs) can be subject to higher excesses than the policy's standard.

Kill Cords


At time of writing it is not a legal requirement in the UK for P&P craft to have kill cords in use whilst the craft is underway. However, some insurers are now making the attaching of kill cords a requirement of their cover for fast craft. Again, check your wording or speak to your provider if you are not sure what your insurance obliges you to do.

Nb. These examples represent only a small part of your policy's terms and conditions. You should carefully read the whole of your policy document to ensure you are aware and fully understand all policy requirements and the scope of cover provided. If in doubt, speak to your insurance provider and obtain clarification from them.

Additional Cover & Free Benefits

Legal Expenses


This cover is usually an "add on" which attracts a charge. A Legal Expenses policy will cover your uninsured losses in the event of a non-fault claim such as your standard policy excess. It might also cover you with regard to contractual disputes and legal defence.

Data Tag


One insurer I work with offers a free data tag to all policy holders. This is particularly useful for RIB owners as, if your outboard should disappear overnight, it is possible for it to be located by the police and the perpetrators apprehended.

Marina Benefits


We have already discussed (in Part 1) the premium benefits you are likely to enjoy if your vessel is kept in a marina. This is due to greater security against theft as well as the marina generally being a safer haven from adverse weather conditions than other types of mooring.

In addition to premium savings you can often benefit from not having your excess applied in the event of a claim arising whilst your RIB is marina berthed. Some insurers will also provide the benefit of not penalising your no-claims bonus in the event of theft or damage occurring whilst your vessel is moored in a marina.

Personal Accident Insurance


This is a useful feature and, in most cases, it usually does come as a genuine free benefit. The sums insured are relatively low (typically £5,000 or £10,000) and do not compare favourably with stand-alone personal accident policies but, nevertheless, would provide some support if an insured event were to occur.

Insurance for Your Business

Insurance for Your Business



The importance of insurance cannot be over-emphasized and neither can the danger of paying for insurance you don't need. It is strongly recommended you solicit the advice of an in-dependent business insurance agent. Don't forget to SHOP! Talk to three or four independent agents and compare notes and prices. An insurance agent will lay out a vast array of insurance coverage much of which you simply may not need. Your situation will be unique and you must consider each insurance element carefully to ensure comprehensive coverage.

Whatever your final insurance program looks like, you should review it at least every six months. Your business can change rapidly, especially in the first few years and insurance needs change with it. Keep your program up to date by calling in your agent and reviewing your coverage. Make changes where necessary.

LIABILITY INSURANCE


This is probably the most important element of your insurance program. Liability insurance provides protection from potential 
losses resulting from injury or damage to others or their property. Just recall some of the big cash awards you have read about that have resulted from lawsuits concerning liability of one kind or another and you will understand the importance of this insurance. Your insurance agent can describe the various types of liability insurance coverage that are available. If you will end up with a comprehensive general policy, make certain that the general policy does not include items you don't need. Pay for only the insurance you need. For example, your business may not need product liability insurance.

Do not confuse business liability coverage with your personal liability coverage, both of which you need. Your personal coverage will not cover a business-generated liability. Check to be certain.

Compare the costs of different levels of coverage. In some cases a $2 million policy costs only slightly more than a $1 million policy. This economy of scale is true with most forms of insurance coverage. That is, after a certain value, additional insurance becomes very economical.

KEY PERSON INSURANCE


This type of insurance is particularly important for the sole proprietorship or partnership where the loss of one person through illness, accident, or death may render the business inoperative or severely limit its operations. This insurance, although not inexpensive, can provide protection for this situation. Key person insurance might also be necessary for others involved in your business.

SGC was a small firm run by three partners, a software programmer, marketer, and a general manager. Their product was a complex computer program used by aerospace firms. Al, the programmer, was involved in a severe automobile accident, became totally disabled, and SGC lost their programming capability. The problem was that the computer program written by Al was essentially the company's sole product. Modifications to accommodate the customer became impossible and the time to bring another programmer up to speed was excessive. SGC lost considerable business as a result of this situation. These losses could have been offset by key person insurance.

DISABILITY INSURANCE


You, as a business owner, should be covered by disability insurance whether or not you decide on key person insurance. This insurance, along with business-interruption insurance, described below, will help ensure your business will continue to operate in the unfortunate situation where you are unable to work. Your disability insurance policy needs to provide satisfactory coverage. Particular attention should be paid to the definition of "disability," delay time until payments start, when coverage terminates, and adjustments for inflation.

FIRE INSURANCE


Fire insurance, like all insurance is complicated and you should understand what IS and IS NOT covered. For example, a typical fire insurance policy covers the loss of contents but does not cover your losses from the fact that you may be out of business for 2-months while your facility is rebuilt. Fire insurance is mandatory whether you're working out of a home office or you have a separate facility. You should discuss a comprehensive policy with your agent. Take the time to understand the details. For example, will the contents be insured for their replacement value or for actual value at the time of loss?

Consider a co-insurance clause that will reduce the policy cost considerably. This means that the insurance carrier will require you to carry insurance equal to some percentage of the value of your property. (Usually around 85%.) With this type of clause it is very important that you review coverage frequently so you always meet the minimum percentage required. If this minimum is not met, a loss will not be paid no matter what its value.

If you are working out of your home, your existing homeowner's policy may not cover business property. If this is the case, have your insurance agent to add a home-office rider to your policy.

AUTOMOBILE INSURANCE


You probably already have automobile insurance but it might not include business use of your vehicle. Make sure that it does.

WORKER'S COMPENSATION INSURANCE


If you make the decision to hire employees, you will be required, in most states, to cover them under worker's compensation. The cost of this insurance varies widely and depends on the kind of work being performed and your accident history. It is important that you properly classify your employees to secure the lowest insurance rates. Work closely with your insurance agent.

BUSINESS INTERRUPTION INSURANCE


This protects against loss of revenue as the result of property damage. This insurance would be used, for instance, if you could not operate your business during the time repairs were being made as a result of a fire or in the event of the loss of a key supplier. The coverage can pay for salaries, taxes, and lost profits.

CREDIT INSURANCE


This will pay for unusual losses as the result of nonpayment of accounts receivables above a certain threshold. As with all policies, you must thoroughly understand the details so discuss it with your insurance agent. One of the largest providers of this coverage is American Credit Indemnity, Baltimore, MD. (800) 879 1224.

BURGLARY/ROBBERY/THEFT INSURANCE


Comprehensive policies are available that protect against loss from these perils, including by your own employees. Make certain you understand what is excluded from coverage.

RENT INSURANCE


This policy covers the cost of rent for other facilities in the event your property becomes damaged to the extent that operations cannot continue in your normal location.

DISABILITY INSURANCE


This insurance will pay you an amount each month slightly less than your current salary in the event you become disabled and are unable to work. Cost for this coverage varies considerably depending on your profession, salary level, how quickly benefits start, and when they end. Benefits paid are tax-free only if you, not your company, pay the premiums.

This list could be continued since it is possible to purchase insurance for just about any peril you can imagine ... if you can pay the premium! When considering your insurance coverage, use the following checklist:

INSURANCE COVERAGE CHECKLIST:


o Can you afford the loss?

o What coverage is required by Federal, state, or local law?

o What SPECIFIC items are covered by the policy?

o Are items to be insured for their replacement cost or original value?

o What SPECIFIC items are EXCLUDED by the policy?

o If there is a co-insurance clause, do you have adequate coverage?

o Have you chosen deductibles wisely in order to minimize costs?

o Do any of the policies you are considering duplicate or overlap one another?

o Do you need any insurance based on location, e.g., flood, earthquake?

Use the following checklist to review your insurance plans:

INSURANCE PLAN CHECKLIST:


o Employ an independent insurance agent rather than going to individual insurance companies. Ensure the agent shops for your insurance.

o Talk to and get quotations from at least THREE agents and pick the best one for you.

o Use money saving comprehensive policies, if possible.

o Perform periodic (every 6-months) reviews of your insurance program.

o Have business assets professionally appraised to determine coverage needs.

o Ensure existing personal insurance coverage includes business-related activities and add riders as necessary or obtain additional coverage.

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Auto Insurance Principles Should Apply to Health Insurance

Auto Insurance Principles Should Apply to Health Insurance


Many Americans rely on their automobiles to get to work. No automobile means no job, no rent or mortgage money, no food. A single parent, struggling to make ends meet in the suburbs with 100,000 miles on the odometer, would presumably welcome the guaranteed opportunity for low-priced insurance that would take care of every possible repair on her auto until the day that it reaches 200,000 miles or falls apart, whichever comes first. Especially if the insurance is valid regardless of whether she even changes the oil in the interim.

So why aren't the auto insurance companies writing such coverage, either directly or through used auto dealers? And given the importance of reliable transportation, why isn't the public demanding such coverage? The answer is that both auto insurers and the public know that such insurance can't be written for a premium the insured can afford, while still allowing the insurers to stay solvent and make a profit. As a society, we intuitively understand that the costs associated with taking care of every mechanical need of an old automobile, particularly in the absence of regular maintenance, aren't insurable. Yet we don't seem to have these same intuitions with respect to health insurance.

If we pull the emotions out of health insurance, which is admittedly hard to do even for this author, and look at health insurance from the economic perspective, there are several insights from auto insurance that can illuminate the design, risk selection, and rating of health insurance.

Auto insurance comes in two forms: the traditional insurance you buy from your agent or direct from an insurance company, and warranties that are purchased from auto manufacturers and dealers. Both are risk transfer and sharing devices and I'll generically refer to both as insurance. Because auto third-party liability insurance has no equivalent in health insurance, for traditional auto insurance, I'll examine only collision and comprehensive insurance -- insurance covering the vehicle -- and not third-party liability insurance.

Bumper to Bumper


The following are some commonly accepted principles from auto insurance:

* Bad maintenance voids certain insurance. If an automobile owner never changes the oil, the auto's power train warranty is void. In fact, not only does the oil need to be changed, the change needs to be performed by a certified mechanic and documented. Collision insurance doesn't cover cars purposefully driven over a cliff.

* The best insurance is offered for new models. Bumper-to-bumper warranties are offered only on new cars. As they roll off the assembly line, automobiles have a low and relatively consistent risk profile, satisfying the actuarial test for insurance pricing. Furthermore, auto manufacturers usually wrap at least some coverage into the price of the new auto in order to encourage an ongoing relationship with the owner.

* Limited insurance is offered for old model autos. Increasingly limited insurance is offered for old model autos. The bumper-to-bumper warranty expires, the power train warranty eventually expires, and the amount of collision and comprehensive insurance steadily decreases based on the market value of the auto.

* Certain older autos qualify for additional insurance. Certain older autos can qualify for additional coverage, either in terms of warranties for used autos or increased collision and comprehensive insurance for vintage autos. But such insurance is offered only after a careful inspection of the automobile itself.

* No insurance is offered for normal wear and tear. Wiper blades need replacement, brake pads wear out, and bumpers get dings. These aren't insurable events. To the extent that a new car dealer will sometimes cover some of these costs, we intuitively understand that we're "paying for it" in the cost of the automobile and that it's "not really" insurance.

* Accidents are the only insurable event for the oldest automobiles. Accidents are generally insurable events even for the oldest autos; with few exceptions service work isn't.

* Insurance doesn't restore all vehicles to pre-accident condition. Auto insurance is limited. If the damage to the auto at any age exceeds the value of the auto, the insurer then pays only the value of the auto. With the exception of vintage autos, the value assigned to the auto goes down over time. So whereas accidents are insurable at any vehicle age, the amount of the accident insurance is increasingly limited.

* Insurance is priced to the risk. Insurance is priced based on the risk profile of both the automobile and the driver. The auto insurer carefully examines both when setting rates.

* We pay for our own insurance. And with few exceptions, automobile insurance isn't tax deductible. As a result, the fear of increasing insurance rates due to traffic violations and/or accidents changes our driving behavior and we sometimes select our automobiles based on their insurability.

Each of the above principles is supported by solid actuarial theory. Although most Americans can't describe the underlying actuarial theories, most everyone understands the above principles of auto insurance at the intuitive level. For sure, as indispensable automobiles are to our lifestyles, there is no loud national movement, accompanied by moral outrage, to change these principles.

Unsustainable Market


In contrast, similar principles are routinely violated in health insurance. To demonstrate this, let's return to the same suburban mother from the opening paragraph. She's busy working, driving to and from work, and driving her kids to school and activities. She ends each day exhausted, sitting on the couch with fast food. She's obese, has a sedentary life, a bad diet, and hasn't taken the time to go to the doctor in years. After a simple injury doesn't heal for weeks, she turns up at the emergency room and learns she has type II diabetes. Although type II diabetes is controllable, changing diet and exercise habits and properly tracking her condition takes time and effort and she's never quite successful in implementing the necessary lifestyle changes.

So the initial emergency room visit is only the first of a long list of health care related to non-controlled diabetes and other problems associated with obesity. Whether she has individual or group insurance, her insurance pays for each episode of care, without singling her out for a premium increase, and without charging her any more cost sharing than is charged to the healthiest and most medically diligent insureds. Her coverage continues until she voluntarily changes insurance companies and/or employers or becomes eligible for Medicare. If she's covered under group insurance she may not even pay any premium. Her insurance continues unabated, even though the disease was caused by neglecting her body and she maintains her poor lifestyle even after the disease becomes known.

This just wouldn't happen in auto insurance. This scenario is the auto insurance equivalent of guaranteed access to low-priced auto insurance that takes care of every possible repair, including damage already done, until the day the car falls apart so completely it's unsalvageable (death) or reaches 200,000 miles (Medicare), regardless of whether she even changes the oil (takes care of herself) in the interim.

As a society, we don't expect this in private-market auto insurance, but we expect it in private-market health insurance. Furthermore, there's a chorus of national and state interests, which continuously pushes us further away from the auto insurance principles.

The current private health insurance market isn't sustainable. Prices have been consistently increasing faster than inflation for decades. Each year, insureds use more health care than ever before and more people have no insurance at all. Most actuaries and other people in the private health insurance market don't want national health insurance with its bureaucracy and one-size-fits-all benefits. Yet, we're trying to sustain a private insurance system, which violates the very principles we know are necessary for private insurance markets.

Yes, health insurance involves the sacredness of human life and is therefore different from auto insurance. But if we're to sustain a private-market solution to health insurance, actuaries need to explain to the larger society, in terms that society understands, the rationale for the following principles:

* As sacred as health care is, it's still an economic transaction that has to be balanced by individuals and societies, against other economic choices. It can't be unlimited. Sometimes it will be secondary to other choices. On a given day, for example, the mother in our scenario may value her car more than her health.

* Insurance premiums should be paid by the individual and tied to controllable risk factors. This will provide the best incentive for the control of risk factors.

* Although it's hard to draw the line between abuse, neglect and ignorance, self-abuse shouldn't be insured and we need to draw that line somewhere.

* The private market can't provide unlimited, self-directed health insurance.

* Routine care and ongoing treatments of chronic conditions can be pre-funded, can even be subsidized, but they don't constitute "insurable events."

* Insurance can't be expected to keep every human body in pristine condition. No amount of health care will prevent everyone's ultimate death.

* Comprehensive, unlimited, non-subsidized private-market coverage isn't possible for people with severely impaired health.

* The private health market can provide limited non-subsidized health insurance, such as protection from accidents, to even health-impaired individuals.

* Individuals who can afford to do so and who take good care of themselves should be able to "buy up" to better coverage. People have the option of buying up for everything else in life.

Discussion of these principles is lacking from most of the current health insurance debate. If society can intuitively understand how similar principles apply to health insurance, then they should be able understand the principles in the health insurance context. We need to initiate the debate.

Small Business Health Insurance - The Best Policy Is A Great Agent

Small Business Health Insurance - The Best Policy Is A Great Agent


I have been a health insurance broker for over a decade and every day I read more and more "horror" stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer. However, what most people fail to realize is that there are very few "loopholes" in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn't until they receive a "denial" letter from the insurance company that they take their policy out to really read through it.

The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan's coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than, what they pay in premiums and how much they have to pay to satisfy their deductible.

For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car, in that, the buyer knows that the engine and transmission are standard, and that power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don't realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that "benefits were denied."

Sure, we all complain about insurance companies, but we do know that they serve a "necessary evil." And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price.

Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they "want" and the benefits they really "need." Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great "curb appeal," I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need? Probably not! In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you $300 dollars more a month?

Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn't the 80/20 plan still offer you adequate coverage? Don't you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn't it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?

Yes, there are many ways you can keep more of the money that you would normally give to an insurance company in the form of higher monthly premiums. For example, the federal government encourages consumers to purchase H.S.A. (Health Savings Account) qualified H.D.H.P.'s (High Deductible Health Plans) so they have more control over how their health care dollars are spent. Consumers who purchase an HSA Qualified H.D.H.P. can put extra money aside each year in an interest bearing account so they can use that money to pay for out-of-pocket medical expenses. Even procedures that are not normally covered by insurance companies, like Lasik eye surgery, orthodontics, and alternative medicines become 100% tax deductible. If there are no claims that year the money that was deposited into the tax deferred H.S.A can be rolled over to the next year earning an even higher rate of interest. If there are no significant claims for several years (as is often the case) the insured ends up building a sizeable account that enjoys similar tax benefits as a traditional I.R.A. Most H.S.A. administrators now offer thousands of no load mutual funds to transfer your H.S.A. funds into so you can potentially earn an even higher rate of interest.

In my experience, I believe that individuals who purchase their health plan based on wants rather than needs feel the most defrauded or "ripped-off" by their insurance company and/or insurance agent. In fact, I hear almost identical comments from almost every business owner that I speak to. Comments, such as, "I have to run my business, I don't have time to be sick! "I think I have gone to the doctor 2 times in the last 5 years" and "My insurance company keeps raising my rates and I don't even use my insurance!" As a business owner myself, I can understand their frustration. So, is there a simple formula that everyone can follow to make health insurance buying easier? Yes! Become an INFORMED consumer.

Every time I contact a prospective client or call one of my client referrals, I ask a handful of specific questions that directly relate to the policy that particular individual currently has in their filing cabinet or dresser drawer. You know the policy that they bought to protect them from having to file bankruptcy due to medical debt. That policy they purchased to cover that $500,000 life-saving organ transplant or those 40 chemotherapy treatments that they may have to undergo if they are diagnosed with cancer.

So what do you think happens almost 100% of the time when I ask these individuals "BASIC" questions about their health insurance policy? They do not know the answers! The following is a list of 10 questions that I frequently ask a prospective health insurance client. Let's see how many YOU can answer without looking at your policy.

1. What Insurance Company are you insured with and what is the name of your health insurance plan? (e.g. Blue Cross Blue Shield-"Basic Blue")

2. What is your calendar year deductible and would you have to pay a separate deductible for each family member if everyone in your family became ill at the same time? (e.g. The majority of health plans have a per person yearly deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each year, even if everyone in your family needed extensive medical care.)

3. What is your coinsurance percentage and what dollar amount (stop loss) it is based on? (e.g. A good plan with 80/20 coverage means you pay 20% of some dollar amount. This dollar amount is also known as a stop loss and can vary based on the type of policy you purchase. Stop losses can be as little as $5,000 or $10,000 or as much as $20,000 or there are some policies on the market that have NO stop loss dollar amount.)

4. What is your maximum out of pocket expense per year? (e.g. All deductibles plus all coinsurance percentages plus all applicable access fees or other fees)

5. What is the Lifetime maximum benefit the insurance company will pay if you become seriously ill and does your plan have any "per illness" maximums or caps? (e.g. Some plans may have a $5 million lifetime maximum, but may have a maximum benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for $5 million of lifetime coverage.)

6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, N.A.S.E. is known for endorsing schedule plans) 7. Does your plan have doctor co-pays and are you limited to a certain number of doctor co-pay visits per year? (e.g. Many plans have a limit of how many times you go to the doctor per year for a co-pay and, quite often the limit is 2-4 visits.)

8. Does your plan offer prescription drug coverage and if it does, do you pay a co-pay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits and/or do you just have a discount prescription card only? (e.g. Some plans offer you prescription benefits right away, other plans require that you pay a separate drug deductible before you can receive prescription medication for a co-pay. Today, many plans offer no co-pay options and only provide you with a discount prescription card that gives you a 10-20% discount on all prescription medications).

9. Does your plan have any reduction in benefits for organ transplants and if so, what is the maximum your plan will pay if you need an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs $350-$500K and this $100,000 maximum may also include reimbursement for expensive anti-rejection medications that must be taken after a transplant. If this is the case, you will often have to pay for all anti-rejection medications out of pocket).

10. Do you have to pay a separate deductible or "access fee" for each hospital admission or for each emergency room visit? (e.g. Some plans, like the Assurant Health's "CoreMed" plan have a separate $750 hospital admission fee that you pay for the first 3 days you are in the hospital. This fee is in addition to your plan deductible. Also, many plans have benefit "caps" or "access fees" for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit "caps" could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance. Access fees are additional fees that you pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 "access fee" per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000. Again, these fees would be charged in addition to your plan deductible).

Now that you've read through the list of questions that I ask a prospective health insurance client, ask yourself how many questions you were able to answer. If you couldn't answer all ten questions don't be discouraged. That doesn't mean that you are not a smart consumer. It may just mean that you dealt with a "bad" insurance agent. So how could you tell if you dealt with a "bad" insurance agent? Because a "great" insurance agent would have taken the time to help you really understand your insurance benefits. A "great" agent spends time asking YOU questions so s/he can understand your insurance needs. A "great" agent recommends health plans based on all four variables; wants, needs, risk and price. A "great" agent gives you enough information to weigh all of your options so you can make an informed purchasing decision. And lastly, a "great" agent looks out for YOUR best interest and NOT the best interest of the insurance company.

So how do you know if you have a "great" agent? Easy, if you were able to answer all 10 questions without looking at your health insurance policy, you have a "great" agent. If you were able to answer the majority of questions, you may have a "good" agent. However, if you were only able to answer a few questions, chances are you have a "bad" agent. Insurance agents are no different than any other professional. There are some insurance agents that really care about the clients they work with, and there are other agents that avoid answering questions and duck client phone calls when a message is left about unpaid claims or skyrocketing health insurance rates.

Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don't be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and does not cover. If you don't feel comfortable with the type of coverage that your agent suggests or if you think the price is too high, ask your agent if s/he can select a comparable plan so you can make a side by side comparison before you purchase. And, most importantly, read all of the "fine print" in your health plan brochure and when you receive your policy, take the time to read through your policy during your 10-day free look period.

If you can't understand something, or aren't quite sure what the asterisk (*) next to the benefit description really means in terms of your coverage, call your agent or contact the insurance company to ask for further clarification.

Furthermore, take the time to perform your own due diligence. For example, if you research MEGA Life and Health or the Midwest National Life insurance company, endorsed by the National Association for the Self Employed (NASE), you will find that there have been 14 class action lawsuits brought against these companies since 1995. So ask yourself, "Is this a company that I would trust to pay my health insurance claims?

Additionally, find out if your agent is a "captive" agent or an insurance "broker." "Captive" agents can only offer ONE insurance company's products." Independent" agents or insurance "brokers" can offer you a variety of different insurance plans from many different insurance companies. A "captive" agent may recommend a health plan that doesn't exactly meet your needs because that is the only plan s/he can sell. An "independent" agent or insurance "broker" can usually offer you a variety of different insurance products from many quality carriers and can often customize a plan to meet your specific insurance needs and budget.

Over the years, I have developed strong, trusting relationships with my clients because of my insurance expertise and the level of personal service that I provide. This is one of the primary reasons that I do not recommend buying health insurance on the Internet. In my opinion, there are too many variables that Internet insurance buyers do not often take into consideration. I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. And, since it does not cost a penny more to purchase your health insurance through an agent or broker, my advice would be to use eBay and Amazon for your less important purchases and to use a knowledgeable, ethical and reputable independent agent or broker for one of the most important purchases you will ever make....your health insurance policy.

Lastly, if you have any concerns about an insurance company, contact your state's Department of Insurance BEFORE you buy your policy. Your state's Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to become a member of a union to qualify for coverage) or isn't being honest with you, your state's Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.

In closing, I hope I have given you enough information so you can become an INFORMED insurance consumer. However, I remain convinced that the following words of wisdom still go along way: "If it sounds too good to be true, it probably is!" and "If you only buy on price, you get what you pay for!"

Insurance In Tort Laws

Insurance In Tort Laws


INTRODUCTION 

This project has been an eye opener for me. It is extremely relevant to the modern times and as the future of India we should understand that it is the common mass that runs the country. Consumer protection rights are an important issue in modern days. The law can be effectively used to stop any abuse of the common people especially illiterate masses who do not understand the rules and regulations which is to be followed while buying particular item. It is law, the controller of the entire society which can stop this abuse from taking place. It can place effective standards guiding a product's genuinity and the proper verification of its price. No extra taxes should be issued according to the seller's wish. I have proceeded by referring to the books written by Avtar Singh, Venkat Rao and others. It has been a wonderful and educational delight in going about this topic and making a project which is of greatest importance in the present day scenario.

DEFINITION OF CONSUMER 

The words "consumer", "consumed", "consumption" is all cognate, and when one is defined, the contents of the definition go into all of them wherever they occur in the same act. 
Section 2 of the act wherein 'consumer' is defined. According to him, the definition of the consumer will not take a client who engaged the advocate for professional services. 
Consumer means any person who- 
- Buys any goods for a consideration which has been paid or promised or partly paid and partly promised or under any system or deferred payment and includes any user of such goods other than the person who buys such goods for consideration paid or promised or partly promised or under any system of deferred payment when such use is made with the approval of the person, but does not include a person who obtains such goods for resale or for any commercial purpose 
- Hires or avails of any services for a consideration which has been paid or promised or partly paid or partly promised or under any system of deferred payment and includes any beneficiary of such services other than the person who hires or avails of the services for the consideration paid or promised or partly paid or partly promised or under any system of deferred payment when such services are availed of with the approval of the first mentioned person but does not include a person who avails of such services for any commercial support

In Black's Law Dictionary it is to mean: 
One who consumes. Individuals who purchase, use, maintain or dispose of products and services. A member of that broad class of people who are influenced by pricing policies, financing practices, quality of goods and services, credit reporting debt collection and other trade practices for which the state and federal consumer laws are enacted.

OBJECTVES OF THE ACT 

The act is dedicated, as its preamble shows, to provide for better protection of rights of consumers and for that purpose to make provisions for the establishment of consumer councils and other authorities for settlement of consumer disputes and for other connected matters. In the statement of objects, reasons it is said that and the act seeks to provide speedy and simple redressal to consumer disputes. Quasi judicial body machinery has been set up at the district, state and central levels. These quasi judicial bodies have to observe the principle of natural justice and have been empowered to give relief to a specific nature and to award, wherever appropriate, compensation to consumers. Penalties for non compliance of orders given by quasi judicial bodies have also been provided. 
The object and purpose of rendering the act is to render simple, inexpensive and speedy remedy to consumers with complaints against defective goods and deficient services and for that quasi judicial machinery has been sought to be set up at the district, state and national levels. These quasi judicial bodies are required to apply the principle of natural justice and have been empowered to give relief of specific nature and appoint wherever necessary, compensation to consumers.

INSURANCE 

An operational definition of insurance is that it is 
- the benefit provided by a particular kind of indemnity contract, called an insurance policy; 
- that is issued by one of several kinds of legal entities (stock company, mutual company, reciprocal, or Lloyd's syndicate, for example), any of which may be called an insurer; 
- in which the insurer promises to pay on behalf of or to indemnify another party, called a policyholder or insured; 
- That protects the insured against loss caused by those perils subject to the indemnity in exchange for consideration known as an insurance premium. 
The influence of insurance on the law of torts has been significant, both on theoretical level and on practice. Insurance has undermined one of the two main functions of awarding of damages, and it has in cast doubt on the value judgements made by the courts in determining which particular test of liability is appropriate in the given circumstances. 
Regardless of whether in the particular circumstances the appropriate principle of liability is intention is malice, fault or strict liability, the purpose of common law damages remains the same. The primary purpose of an award of damages is to compensate the victim for his loss, with view to restoring him as near as possible to the position he would have been in but for the tort of the wrongdoer. But damages have another: by making the wrongdoer responsible for meeting an award of damages, the courts are trying to deter others from committing similar tortuous wrongs.

Insurance vitiates the secondary purpose of damages, at the same time incidentally ensuring that the primary purpose is more often achieved. 
It can scarcely be realistically asserted that insured defendants are deterred by the prospect of losing no-claims bonus or by increasing of premium on renewal of their policies. Once it is conceded that insurance renders compensation for the sole purpose of damages but then the tort action itself becomes vulnerable to attack, for there are many ways-some perhaps fairer and administratively cheaper than tort- of compensating a victim for a loss he has suffered. 
Prima facie, where a person suffers loss of recognized kind as the result of another's act, then the latter should have to make good that loss. But for valid reasons, the courts have held that, in certain circumstances, the actor will have to compensate his victim only if he is at fault. The victim's right to compensation is, therefore curtailed in an attempt to be fair to both the parties. The courts have made a policy decision that, in the circumstances, it is right to reward a defendant who has been careful by protecting him from liability for the consequences of his actions and that, as a corollary the plaintiff must forego his compensation. The policy decision is made on the supposition that the wrongdoer would himself have to pay for the damages but for this protection; it by no means follows that the same decision would be made if there were no risk of the wrongdoer having to provide the compensation.

It is difficult to judge the victim's right to compensation should be curtailed when that curtailment is not justified by a corresponding benefit to the wrongdoer. The requirement of fault ceases to play its role as the leveler between the victim's legitimate expectations and the wrongdoer's legitimate expectations, and becomes simply a hurdle to the victim's progress to compensation. If it is accepted that no one can insure against liability for harm caused by intentionally to another , then similar arguments can be made by the inappropriateness of the victim's having, in certain circumstances to prove an intention to do him wrong or harm, when it is irrelevant to the wrongdoer whether he had such an intention or not.

Again the victim's right to compensation is being curtailed without any corresponding benefit to the wrongdoer. 
However, insurance has influenced the law of tort on a much more practical level as well. While the fact of insurance is not of itself a reason for imposing liability , there can be no doubt that it does add "a little extra tensile strength" to the chain which a wrongdoer to his responsibilities. 
As well it has given new horizon to damages ; it is true that traditionally it was considered to inform the court that a defendant was insured , but "those days are long past" and now it is frequently openly recognized that the defendant would be insured.

The policy of insurance constitutes a contract of insurance between Life Insurance Corporation or a subsidiary of General Insurance Company of India, as the case may be, such services such has been undertaken to render under the contract of insurance. However as a rule, occasion to render services arise only when insured surrenders his policy, or the policy matures for payment or the insured dies or any other contingency which gives rise to render service occurs. 
Breach of contract of insurance may give rise to a cause of action to file a civil suit, but such breach of contract may itself constitute deficiency in service, so as to give a cause of action to file a complaint under the consumer protection act for one such more relieves awardable hereunder. 
Section 13(4) of the act vests in a redressal agency powers of the Civil Court, while trying a suit in respect of such matters as examination of witnesses on oath and production of documents. Declining to exercise jurisdiction in a case before it only because it involves examination and cross examination of facts, witnesses and production and consideration of documents would amount to abdication of its jurisdiction.

Such discretion can be exercised only when the gives rise to several issues and necessities taking of voluminous oral and documentary evidence, or otherwise involve complex questions of fact and law which cannot be decided in time bound proceedings under the consumer protection act.

MOTOR VEHICLE INSURANCE 

Where the sale of a vehicle is complete, the title therein passes to the purchaser notwithstanding that his name has not been recorded in the R.C.Book. Such owner is entitled to get his vehicle insured and also to maintain a claim on the basis of such insurance. The earlier owner, who has lost insurable insurance on the sold vehicle, cannot advance a claim on the basis of policy of the said vehicle, earlier taken by him, on the ground that he is still the recorded owner of the said vehicle. 
Section 157 of the motor vehicles act is only in respect of third party risks and provides that the certificate of insurance described therein shall be deemed to have been transferred in favour of the person to whom the motor vehicle is being transferred. It does not apply to other risks, if any, covered by the policy. If the transferee wants to avail the benefits of other risks covered by it, he has to enter into an agreement thereof with the investor.

FRAUD BY INSURER 

If it is established that the discharge voucher was obtained by fraud, misrepresentation, undue influence or coercive bargaining or compelled by circumstances, the authority of the consumer forum may be justified in granting relief. Mere execution of the discharge voucher would not deprive the consumer of his claim in deficiency of service.

DELAY IN SETTLEMENT OF CLAIM 

In Sarveshwar Rao v. National Insurance Company Ltd. , it was held that the delay of two or more years in settling the insurance claim would result in inadequacy in the quality, nature and manner of the service which the insurance company has undertaken to render, and amounts to deficiency in service. 
In Delkon India Pvt. Ltd. V. The Oriental Insurance Company Ltd. . The National Commission has held that it was a deficiency of service to have delayed the claim by two years on the ground that the final police report was not coming.

INTERPRETATION OF TERMS


In Skandia Insurance Company v. Kokilaben Chandravadan , the honorable Supreme Court ruled that the exclusion terms of the insurance must be read with so as to serve the main purpose of the policy, which is to indemnify the damages caused to the vehicle.

CONDUCT OF THE INSURER 

In Oriental Insurance Co. Ltd. V. Mayur Restaurant and bar , the conduct of the insurer was under question. The commission held that deficiency of the service was established on the part of the opposite party on two counts i)delay in settlement of claims and ii) unreasonable and un maintainable reasons for repudiating the claim of the complainant, and the compensation with the interest and cost was awarded.

SUICIDE BY THE ASSURED 

In Life Insurance Corporation v Dharma Vir Anand, the national commission refused to hold the insurance commission liable as the insured committed suicide before the expiry of three years from the date of the policy.

BREACH OF TERMS 

In B.V.Nagarjuna v Oriental Insurance Company Ltd., the terms of insurance contract permitted the insured vehicle to carry six passengers at a time but the driver allowed two more persons to get in. It was held that merely adding two more persons without the knowledge of the driver did not amount to indemnification by the insurance company.

NOMINEE'S RIGHTS 

In Jagdish Prakash Dagar v. Life Insurance Corporation , it was held that a nominee under a policy of life insurance will be a consumer within the meaning of section 2(1) (d) of the Consumer Protection Act. The commission held that the nominee could legislatively maintain an action against deficiency raised in service by the arbitrary decision of the insurer.

REPUDIATION 

Repudiation is defined as the renunciation of a contract (which holds a repudiator liable to be sued for breach of contract, and entitles the repudiatee on accepting the repudiation to treat the contract as at an end 
This concept of repudiation is needed in the concept of insurance. The concept of repudiation will be dealt hereto a number of times and to provide beneficiary evidence, the definition has been given. 
Unilateral repudiation of its liability, under the contact of by the life insurance corporation or an insurance company does not, by itself oust the jurisdiction of a redressal agency, to go into the sustainability of such repudiation, on facts and in law and to decide and to adjudicate if, in the facts of the case, it amounts to deficiency in service or unfair trade practice, and if so, to award to the aggrieved person, such relief or reliefs under Section 14(1) of the said Act as he or she is entitled to. The fact that before such repudiation it obtained a report from a surveyor or surveyors also does not oust the jurisdiction of a redressal agents to into the merits of such repudiation, for otherwise in each case the corporation or such company, and deprived the aggrieved person of the cheap and expeditious remedy under the consumer protection act. 
Where, however the corporation or the company conducts thorough investigations into the facts which have given rise to claim and other associated facts, and repudiates the claims in good faith after exercise with due care and proper application of mind, the redressal agency should decline to go into the merits of such repudiation and leave the aggrieved person to resort to the regular remedy of a suit in a civil court. 
The law does not require the life insurance corporation or an insurance company to accept every claim good or bad, true or false, but it does require the corporation or the company to make a thorough investigation into such claim and to take decisions on it, in good faith, after exercise of due care and proper application of mind and where it does so it renders the service required by it and cannot be charged with deficiencies in service, even if, in the ultimate analysis, such decisions is wrong on the facts and in law and the redressal agency would be disinclined to substitute its own judgement in the place of the judgement of the corporation or insurance company. 
The question as to whether repudiation of its liability does or does not amount to deficiency in service would depend upon the facts of each case. 
Where a cheque sent towards a premium is dishonoured by the drawee bank and consequently the policy is cancelled or it lapses or the injured dies before the proposal is accepted and contract of insurance results, no claim can be founded in such a policy, which was cancelled or has since lapsed, or a contract of insurance, which did not materialize at all. Repudiation of such claim can never amount to deficiency in service. 
Insurance agent is not entitled to collect premium on behalf of the corporation. Where an insured issues a bearer cheque towards premium and hands it over the insurance agent who encashes it, but does not deposit the premium with the corporation event till the expiry of the grace period and consequently the policy lapses and meanwhile the insured also dies, his nominee has to blame himself or herself for the indiscretion of the insured and cannot blame or fault the corporation.

BASIC PRINCIPLES OF INSURANCE


There are some basic principles concerning the topic of Consumer Protection Law and Insurance. 
- Settlement of insurance claim is service, default or negligence therein is deficiency of that service 
In the case of Shri Umedilal Agarwal v. United India Assurance Co. Ltd, the National Commission observed as under: 
"We find no merit in the contention put forward by the insurance company that a complaint relating to the failure on the part of the insurer to the settle the claim of the insured within a reasonable time and the prayer for the grant of compensation in respect of such delay will not within the jurisdiction of the redressal forums constituted under the consumer protection act.

The provision of facilities in connection with insurance has been specifically included within the scope of the expression "service" by the definition of the said word contained in section 2(i) (o) of the act. Our attention was invited by Mr. Malhotra, learned counsel for the insurance company to the decision of the Queen's Bench in national transit co. ltd. V. customs and central excise commissioners . The observations contained in the said judgement relating to the scope of the expression insurance occurring in the schedule of the enactment referred to therein are of no assistance to all of us in this case because the context in which that expression is used in the English enactment considered in that case is completely different. Having regard to the philosophy of the consumer protection act and its avowed object of providing cheap and speedy redressal to customers affected by the failure on the part of persons providing service for a consideration, we do not find it possible to hold that the settlement of insurance claims will not be covered by the expression insurance occurring in section 2(1)(d).Whenever there is a fault of negligence that will constitute a deficiency in the service on the part of the insurance company and it will perfectly open to the concerned aggrieved customer to approach the Redressal Forums under the act seeking appropriate relief."

- L.I.C. Agent has no authority in collecting the premium 
The supreme court held that under regulation 8(4) of life insurance corporation of India (agents) regulation, 1972 which had acquired the status of life insurance corporation agents rules with effect from January 31, 1981, which were also published in the gazette, LIC agents were specifically prohibited from collecting premium on behalf of LIC and that in view thereof an inference of implied authority cannot also be raised.

- Rejection of claim as false after full investigation 
The national commission held as follows: 
" from the facts disclosed by the record and particularly averments contained in the consumer affidavit filed by the first respondent it is seen that the insurance company had fully investigated into the claims put forward by the complainant that his claim was rejected. Thus it is not a case where the insurance company did not take a prompt and immediate option for deciding the claims against the insurance company. Having regards to the facts and circumstances of this case and the nature of the controversy between the parties we consider that this is a matter that should be adjudicated before a civil court where the complainant as well as the respondent will have ample opportunities to examine witnesses at length, take out the commission for local inspections etc. and have an elaborate trial of the case."

- Unilateral reduction in the insurance amount. 
The national commission held that the insurance company is not entitled to make a unilateral reduction of Rs. 4, 29,771 from Rs. 30, 12,549 at which its own surveyor assessed the loss.

- Mere repudiation does not render the complaint not maintainable. 
The national commission overruled the objection of the insurance company that merely because the insurer had totally repudiated its liability in respect of the claim, no proceedings could validly be initiated by the insured under the consumer protection act.

- Mere unilateral repudiation does not oust the jurisdiction. 
The national commission held that merely because the insurer has repudiated the insurance claim under the policy unilaterally, it is difficult to hold that the various redressal forums constituted under the consumer protection act, 1986 will have no jurisdiction to deal with the matter that if such a contention of the insurance company can get a report from the surveyors, repudiate the claim and oust the jurisdiction of the redressal forums, that the redressal forums are, therefore, bound to see whether or not the repudiation was made in good faith on valid and justifiable grounds that if the surveyor or surveyors choose to submit the wrong report and the insurance company repudiates the claims without applying its mind then the repudiation cannot be said to be justified that the report of the surveyor will show that the investigations have been proper, fair and thorough and that it has to be remembered that the surveyors bread comes from the employer.

- Mere unilateral repudiation no ground to oust jurisdiction. 
The national commission repelled the objection and observed as under: 
"Ordinarily a remedy is available to a consumer in Civil Court but mere repudiation of claim arising out of policy of insurance under section 45 of the insurance act, 1938, cannot take away the jurisdiction of the redressal forum constituted under the act. The avowed object of the act is to provide cheap, speedy and efficacious remedy to the consumers and it is with this object that section 3 of the act lies down as follows: 
3. Act not in derogation of the provisions of any other law: - the provisions of this act shall be in addition to and not in derogation of the provisions of any other law for the time being in force." 
The national commission overruled the objection in the view of repudiation of contract of insurance by the corporation; the redressal agencies under the act cannot entertain the claim of the insured and reiterated the law laid down by it in the Divisional Manager, Life insurance Corporation of India, Andhra Pradesh v. Shri Bhavnam Srinivas Reddy.

- Removal of insured goods on attachment no theft. 
It was ruled in the stated case that attachment of certain items of insured Machinery and goods by the bailiff of a civil court, though later found to be illegal and consequent removal did not amount to theft and or house breaking by force so as to entitle the insured to prefer a claim under the policy.

- When repudiation amounts to deficiency and when it does not? 
The national has held: 
In M/s Rajdeep Leasing and Finance and others v. New India Assurance Company Limited and others - 
That rejection of the claim by the insurance company after examining and considering the two separate survey reports from qualified surveyors and three legal opinions from different oriental counsels could not be said to constitute a deficiency in service so as to give a rise in the cause of action for a complaint under the consumer protection act. 
In Oriental Insurance Co. Ltd. V Modern Industries Ltd. , the national commission has held that where the cover note inter alia mentions that the risk is subject to the usual terms and conditions of the standard policy, it is equally the responsibility of the complainant to call for these terms and conditions even if they are not sent by the insurance company, as alleged, to understand the extent of risk covered under the policy and associated aspects.

In Life Insurance Corporation of India v. Dr. Sampooran Singh 
The complainant had taken out an insurance policy of 40,000 rupees in 1982, for the purpose of payment of estate duty on his only residential house in chandigarh in the event of his death and paid 5 premia, but with the abolition of estate duty on one residential house owner in 1985, the policy became inoperative due to the act of the state and not due to any deficiency on the part of the corporation any dispute between the parties as to the amount payable there under cannot be construed as deficiency in service on part of the corporation.

In LIC of India v M/s Kanchan Murlidhar Akkalwar 
The complainant applied to the opposite party for housing loan, and on the advice of the latter, she took two LIC policies, one for Rs. 90000 and the other for Rs. 20000 entered into an agreement for the purchase of the house with the house with the owner on the advice of the opposite party obtained a fire policy for Rs. 2 lakhs. The opposite party advised the complainant to obtain a release deed from the zilla parishad co operative society in respect of the she proposed to purchase with a certificate that the said plot is not mortgaged therein. The complainant got a certificate from the Maharashtra government that the vendor had re paid the housing loan and interest thereon due to Zilla Parishad Krishi Karmachari Sehakari Gribe Narman Sanstha and that there was nothing outstanding from him towards loan amount or interest. Still the opposite party did not release the loan. On these facts the national commission by its majority judgement observed that: 
"We have carefully gone through the records and heard the counsel. Clause 1 (c) of the loan offer letter clearly states that the advance of the loan is subject to the property being free from encumbrances to the satisfaction of the insurance company and a good and marketable title. At the same time it appears that the respondent-complainant had to go through a number of steps, although necessary, having financial implications and causing mental and physical stress to her and at the end of all of which she was told that no dues certificate given by the maharashtra government in respect of the prospective seller of the property in question, was not "release of mortgage" certificate that was obtained. The respondent complainant perhaps also had in her mind the case of Mr. Vaishempayam who got the loan under similar circumstances. Thus the evasion petition is disposed of as above."

CONCLUSION 

This project topic is increasingly beneficial in the modern times with the consumer protection rights being redressed with due care. It is being advertised in the mass media in our country. The slogan which our consumer is using is: "JAGO GRAHAK JAGO". The time has come to realize the ideal market situation in which the buyers are not persuaded or coerced falsely into buying items which are of no use to them at all. Besides the relationship between buyer and seller should not be damaged at any cost. The relationship between the buyer and seller is said to be a fiduciary relationship and the trust between them should remain intact. A time has come in which the customer should get his proper position in the market conditions. He has to have proper knowledge about what is going on in the market and the concerned prices and the supply and the different other practices referred to. 
Insurance is a very sensitive issue in the modern times. People are being hoodwinked into signing up in companies which are turning out to be frauds in the true sense of the term. This project has been an eye opener to me and I have come to realize the importance of the consumer protection act and insurance.

Mexican Tourist Auto Insurance - Tips on How to Purchase Insurance For Mexico

Mexican Tourist Auto Insurance - Tips on How to Purchase Insurance For Mexico


Congratulations - you are embarking on an exciting road trip adventure to Mexico. You have your vehicle tuned and all of your gear packed, and now it is time to purchase your Mexican tourist auto insurance. Your Mexican auto insurance coverage decision could be the most important decision you make, but unfortunately it is often one of the most rushed and least researched decisions that many Mexico travelers make. Do not make the mistake of assuming that all Mexican insurance is the same, because the differences in insurance coverages and benefits can vary tremendously between Mexico insurance companies. Even though researching insurance coverage is not very exciting for most people, this article will show you how 5 to 10 minutes of research on the internet could save you thousands of dollars and many frustrating hours if you were to actually need to use your Mexico insurance to pay for a loss.

Use the internet to quote and purchase Mexican tourist auto insurance


The vast majority of Mexican auto insurance is now purchased directly from the internet. There are a number of websites that sell Mexico insurance, and buying your insurance from the internet makes a lot of sense for the customer. Would you rather wait till the last minute to buy your insurance at the border, or would you prefer to buy your insurance from the convenience of your own computer before you leave on your trip to Mexico? Most customers prefer to get their insurance taken care of ahead of time.

The best websites to buy your Mexico insurance from are ones that offer multiple Mexico insurance companies. This allows you to do comparison shopping through one website instead of filling out multiple quotation forms on multiple websites. One good Mexican insurance website with a comparison insurance rater will save you a lot of time and confusion.

Which websites can be trusted?


Before getting your insurance quote, make sure to look for a valid insurance license and contact information. Also, you may want to look for a 'Surplus Lines Broker' license number. A surplus lines broker is an insurance broker who has a direct contract with the Mexican insurance companies and is licensed to sell foreign insurance coverage within the United States. A surplus lines broker license is a good sign that the website is run by a company who specializes in Mexico insurance. If the insurance license is not a surplus lines broker license, this means the website is most likely run by an insurance agent who is selling through a surplus lines broker. This does not mean the products on the website are not valid, but you may not receive the same level of customer service as you would from a surplus lines broker who specializes entirely in Mexican insurance. You may also want to look for a Better Business Bureau listing and some sort of internet security approval such as Hacker Safe or McAfee Secure to ensure that your information will be secure during your internet transaction.

Mexico insurance coverage to look for


Once you have selected a website that sells Mexico tourist auto insurance, you will fill out the quick insurance quote form. Within a minute, you should be able to get a firm quote and begin researching the benefits of the insurance products offered. Remember, this will be a much quicker and streamlined process if you use a website that offers multiple competing insurance companies all under one quoting system (a comparative quote rater).

Look for a chart below or above the insurance prices that clearly explains exactly what the Mexico insurance limits are and what is actually covered. In this chart, you will want to look at the following categories:

Deductibles: The best Mexican insurance policies will offer fixed deductibles, meaning the deductibles will be locked at a set amount regardless of what the value of your vehicle is. Some of the less expensive policies will base deductibles on a percentage of the vehicle value. If the vehicle's value is less than $20,000, percentage based deductibles may be fine, but when vehicle values get up in the $30,000 range or higher, the percentage based deductibles can get very high. If the website does not specifically list the deductibles, you should not use that website!

US Hourly Labor Rates for Repairs Made in the US or Canada: In the old days, most Mexican auto insurance companies tried to make customers repair their vehicles in Mexico. Repairs made in Mexico instead of the US were often much less expensive for the Mexican insurance companies, and many customers were unwilling to leave their car in Mexico, so the company got out of paying these claims. Today, many of the better Mexico insurance programs allow you to fix your vehicle in the US or Canada if you wish. The catch is that some of the less expensive Mexican insurance programs will only pay a limited hourly labor rate for repairs made in the US (some as low a $20 per hour). This means the customer would have to pay the difference in hourly labor rates out of their pocket. The best Mexican insurance programs will pay very high US labor rates such as $70 per hour or state that they will pay whatever the current US hourly labor rate is. These policies could significantly minimize your out of pocket expenses in the event of a claim. If the Mexico insurance website does not specify if repairs in the US are allowed or what the hourly labor rate is, do not use that website to purchase your Mexican insurance!

Vandalism and Partial Theft Coverage: Vandalism and partial theft (meaning only part of the car is stolen such as the tires, door panels, etc) is typically not covered by standard Mexican auto insurance. In the past few years the higher quality Mexican insurance programs have started to offer this coverage in their enhanced coverage programs. If you want to protect yourself against as many types of losses as possible, you should look for this coverage.

Liability Limits: This is the portion of the Mexican insurance policy that pays for damages you cause to third parties. This coverage is essential when traveling in Mexico. Most people in the industry feel that $50,000 worth of liability insurance is probably the minimum you should consider. Some of the best Mexican insurance programs will go up to $300,000 combined single limit (a lump sum for property damage or bodily injury damages), but it will also increase the insurance premium. Some customers wish to carry these higher limits to work in tandem with their US umbrella liability policies. You may want to ask your US insurance provider if your umbrella insurance will recognize your Mexico auto insurance as a primary coverage.

Medical Payments: This is the portion of the Mexico insurance policy that pays for medical costs for you and your passengers (people inside your vehicle). $2,000 per person with a total of $10,000 per accident is the lowest limit you should consider, but many policies will offer much higher limits. Some of the better policies will also increase this amount if you are hit by an uninsured motorist who is at fault. You may want to check with your US or Canadian health insurance provider to make sure they will cover you for medical costs incurred while traveling in Mexico. If not, you may also want to research an international health insurance plan - but that is a different subject.

Legal Service: Make sure your Mexico insurance includes legal service or legal assistance. This coverage will pay for any court costs, attorney fees, or bail payments that are a result of a traffic accident in Mexico. The service will also dispatch a legal representative to hold your hand through any legal procedures. This coverage is absolutely essential, so do not purchase any Mexico auto insurance that does not include this coverage!

Road Assistance: Most of the better Mexico insurance companies will include some level of road assistance that will cover towing expenses, flat tires, locksmith, and other services. This is a great coverage to have, so make sure this is included with your Mexico insurance policy.

Medical Evacuation: As the market for Mexican insurance becomes more competitive, many Mexico carriers are now bundling in extra special coverages to make their products stand out. When medical evacuation is automatically included with your Mexico auto insurance, it is an incredible value and convenience. This coverage will coordinate and pay for air or land ambulance services in the event of 'grave illness or injury'. This means life threatening or very serious illnesses or injuries. Purchasing a medical evacuation program on your own will often cost hundreds of dollars per year, and can often have many limitations. The quality Mexico auto insurance programs that bundle in the medical evacuation coverage will usually cover multiple people in your travel group automatically up to four or more people. Make sure to look for how many people are covered by the medical evacuation. If the amount of people covered is not listed in the insurance quote details, you can assume that the medical evacuation may only cover the driver. Other websites do exist that specifically cover 4 or more people in your travel group, so it is highly recommended that you look for websites that offer this broader medical evacuation coverage.

Plane Tickets Home: Another great benefit that many of the better Mexico insurance websites are offering is plane tickets home in the event that your car is stolen or not drivable. This can save you thousands of dollars, and alleviate the nightmare of needing to coordinate your transportation back to your home from Mexico. If this benefit is offered, make sure to see for how many people the policy will provide plane tickets home. If plane tickets home is not listed, or the website does not specify how many people are covered, you should check a different website. A few websites do offer coverage for four people or more in your travel group.

When in doubt, call the website customer service phone line for help


The reputable Mexico insurance websites will encourage you to call their customer service departments if you have questions about the Mexico insurance. If nobody answers the phone, or does not call you back within a few minutes (during normal business hours), you may not want to purchase your insurance from that website! Most Mexico insurance websites are like ATM machines. The website is there for your convenience if you want to write the policy yourself, but you are also welcome to call the website customer service insurance agents and have the agents write the policy for you over the phone.

If you check for each of these insurance coverages and website features while shopping for Mexican auto insurance on the internet, you are guaranteed to purchase the best insurance for your situation. Five to ten minutes of research could save you thousands of dollars and hours, if not weeks, of headaches in the event that you need to file a Mexican insurance claim. Be safe, and have fun in Mexico!