Mis-selling of health insurance policies is a growing concern, with many consumers falling victim to unethical practices by agents or insurers. Mis-selling occurs when policies are sold under false pretences, with incomplete information, or through coercion, leading to financial and emotional distress. This article explores how to identify mis-sold policies, your rights as a consumer, and the steps to seek legal remedies.

Identifying Mis-Sold Health Insurance Policies

Mis-selling can take various forms, including:

• False Promises: Agents may exaggerate benefits or make unrealistic claims about coverage.
• Incomplete Disclosure: Important details like exclusions, waiting periods, or premium terms are omitted.
• Pressure Tactics: Consumers are coerced into buying policies they don’t need.
• Mismatched Policies: Selling a policy that doesn’t align with the buyer’s requirements.

To identify if you’ve been mis-sold a policy:

• Review all policy documents carefully.
• Compare the promised benefits with the actual terms in the contract.
• Check for discrepancies in premium amounts or coverage details.

Your Rights as a Consumer

The Insurance Regulatory and Development Authority of India (IRDAI) has implemented several measures to protect consumers:

• Free-Look Period: Policyholders have 15-30 days to review and cancel their policy if terms are unsatisfactory.
• Right to Information: Insurers must provide clear and complete details about the policy.
• Grievance Redressal Mechanisms: Consumers can file complaints with insurers, escalate them to IRDAI, or approach the Insurance Ombudsman.

Steps to Seek Compensation for Mis-Selling

If you believe you’ve been mis-sold a health insurance policy, follow these steps:

1. Gather Evidence

• Collect all relevant documents such as policy papers, emails, call recordings, and promotional materials that highlight discrepancies.
• Maintain detailed records of all interactions with the insurer or agent.

2. File a Complaint with the Insurer

• Draft a formal complaint explaining how the policy was mis-sold.
• Attach supporting evidence and request specific resolutions (e.g., refund or cancellation).
• Submit the complaint via email for written proof and track its status.

3. Escalate to Grievance Redressal Officer

• If unsatisfied with the insurer’s response, escalate the matter to their Grievance Redressal Officer (GRO).
• Insurers are required by law to respond within 15 days.

4. Approach IRDAI

• If GRO fails to resolve your complaint, file a grievance with IRDAI’s Integrated Grievance Management System (IGMS).
• IRDAI will investigate and mediate between you and the insurer.

5. Contact the Insurance Ombudsman

• For unresolved disputes, approach the Insurance Ombudsman in your jurisdiction.
• The Ombudsman provides free arbitration services for claims up to ₹20 lakhs.

6. Legal Action

• As a last resort, file a case in consumer court seeking compensation for financial losses or mental harassment caused by mis-selling.

Preventing Mis-Selling: Tips for Consumers

• Always verify an agent’s credentials before purchasing a policy.
• Read all terms and conditions thoroughly before signing.
• Consult trusted advisors or family members if unsure about a policy’s suitability.
• Avoid making hasty decisions under pressure from agents.