Policy Document - Terms and Conditions of your policy

ICICI Pru iProtect Smart of India (IRDAI). 35.Regular Pay means premiums need to be paid regularly
throughout the Policy Term. 36.Revival of a policy means restoration of the policy,
A Non-Par Non-Linked Life Individual pure risk insurance product
which was discontinued due to the non payment of premium, by Us with all the
PART-B benefits mentioned in the Policy document, with or without rider benefits if any, upon
Definitions the receipt of all the premiums due and other charges or late fee if any, during the
1. Age means the age of the Life Assured in completed years as on Date of revival period, as per the terms and conditions of the Policy, upon being satisfied as
commencement of risk. 2. Accident means a sudden, unforeseen and involuntary to the continued insurability of the insured or Policyholder on the basis of the
event caused by external, visible and violent means. 3.Accelerated Critical Illness information, documents and reports furnished by You, in accordance with Board
Benefit (ACI Benefit) means the benefit, which is payable upon the Life Assured approved underwriting Policy. 37.Revival period means the period of five
being diagnosed on first occurrence of any of the covered 34 Critical Illnesses. 4. consecutive complete years from the due date of the first unpaid premium.. 38.Single
Accelerated Critical Illness (ACI) Benefit Term means the period between the Policy Pay means premium needs to be paid only once at the inception of the Policy.
Acceptance Date and the Date of Maturity of Accelerated Critical Illness Benefit Term 39.Sum Assured means the amount specified in the Policy Schedule. 40.Surrender
specified in the Policy Schedule. 5. Accidental Death Benefit Term means the period means complete withdrawal/termination of the entire policy contract. 41.Surrender
between the Policy Acceptance Date and the Date of Maturity of Accidental Death value means an amount, if any, that becomes payable on Surrender of this policy
Benefit Term specified in the Policy Schedule. 6. Annualized Premium shall be the during the Policy term, in accordance with the terms and conditions of the policy.
premium amount payable in a year excluding taxes, rider premiums, underwriting 42.Total Premiums Paid means the total of all premiums paid under the base
extra premiums and loadings for modal premiums. 7. Appointee means the person product excluding any extra premium and taxes, if collected explicitly. 43.Unexpired
appointed by You to receive the benefits payable under the Policy till Your Nominee is risk premium value means an amount, if any, that becomes payable in case of
a minor. 8. Death Benefit means the benefit, which is payable on death or diagnosis surrender or discontinuance of premium in single/ limited pay policies in accordance
of Terminal Illness of the Life Assured whichever is earlier during the Policy Term as with the terms and conditions of the Policy. 44.You or Your means the Policyholder of
specified in the Policy Document. 9. Death Benefit Payout Option is the manner in the Policy at any point of time. 45.We or Us or Our or Company means ICICI
which the Nominee receives the Death Benefit payable under the Policy. 10. Prudential Life Insurance Company Limited.
Claimant means the person entitled to receive the Policy benefits and includes You, PART-C
the nominee, the assignee, the legal heir, the legal representative(s) or the holder(s) 1. Benefits available under the policy:
of succession certificate as the case may be. 11. Date of commencement of risk is
1.1 Death Benefit
later of Policy Issue Date or Policy Acceptance Date 12. Date of Maturity is the date
specified in the Policy Schedule on which the policy stands terminated with all rights We shall pay the Death Benefit as per the Death Benefit Payout Option stated on
and benefits thereunder. 13.Date of Maturity for ACI and ADB Benefit term means Your Policy Schedule upon diagnosis of Terminal Illness or death of the Life Assured
the date mentioned in the policy schedule on which the ACI and ADB stands whichever is earlier during the Policy Term. This is applicable provided all due
terminated with all rights and benefits thereunder. 14.Hospital A hospital means any premiums have been paid and the Policy is in force as on the date of diagnosis of
institution established for in-patient care and day care treatment of illness and/or Terminal Illness or the date of death of the Life Assured. A Life Assured shall be
injuries and which has been registered as a hospital with the local authorities under regarded as “Terminally Ill” only if that Life Assured is diagnosed as suffering from a
Clinical Establishments (Registration and Regulation) Act 2010 or under enactments condition which, in the opinion of two independent Medical Practitioners, specializing
specified under the Schedule of Section 56(1) and the said act Or complies with all in treatment of such illness, is highly likely to lead to death within 6 months. The
minimum criteria as under: i. has qualified nursing staff under its employment round terminal illness must be diagnosed and confirmed by Medical Practitioners registered
the clock; ii. has at least 10 in-patient beds in towns having a population of less than with Indian Medical Association and approved by Us. We reserve the right for
10,00,000 and at least 15 in-patient beds in all other places; iii. has qualified medical independent assessment of the Terminal Illness. Death Benefit would be as per the
practitioner(s) in charge round the clock; iv. has a fully equipped operation theatre of below table:
its own where surgical procedures are carried out; v. maintains daily records of Premium
patients and makes these accessible to the insurance company’s authorized Payment Death Benefit
personnel; 15.Insured event means occurrence of an event specified in this Policy on Option
which the benefits shall become payable. 16.Income Term means a period as chosen Regular Pay Higher of 7 times the Annualized Premium; or 105% of the Total Premiums
by You at policy inception and as specified in the Policy Schedule during which the and Limited Paid up to the date of death or diagnosis of terminal illness; or the Sum
Death Benefit is paid out as monthly income to the Claimant. 17.Life Assured means Pay Assured chosen by You ,as stated on your policy schedule.
the person named in the Policy Schedule on whose life the Policy has been issued. Single Pay
Higher of 125% of the single premium; or Sum Assured chosen by You, as
18.Limited Pay means premiums need to be paid regularly for a limited number of stated on your policy schedule.
years of the Policy Term. 19.Medical Practitioner is a person who holds a valid a. In the event of the death of the Life Assured or where the Life Assured is
registration from the Medical Council of any State or Medical Council of India or diagnosed with terminal illness on the Date of Maturity then Death Benefit shall not
Council for Indian Medicine or for Homeopathy set up by the Government of India or be payable. b. The Death Benefit will reduce by the extent of the ACI Benefit claim
a State Government and is thereby entitled to practice medicine within its paid if the Death Benefit is higher than the ACI Benefit. ACI Benefit is as explained in
jurisdiction; and is acting within the scope and jurisdiction of licence The Medical section 1.4 below. c. The Policy shall terminate upon payment of the Death Benefit. d.
Practitioner should neither be the insured person(s) himself nor related to the insured The Death Benefit amount may be taxable as per the prevailing tax laws.
person(s) by blood or marriage nor share the same residence as the Life Assured. 20.
Nominee means the person named in the Policy Schedule who has been nominated 1.2 Waiver of Premium on Permanent Disability due to accident
by You to receive benefits in respect of this Policy. 21. Policy means the contract of a. Upon the diagnosis of Permanent Disability (as defined below) of the Life Insured
Insurance entered into between You and Us as evidenced by the “Policy document”. which arises due to an Accident, We shall waive all future premiums payable for all
22. Policy Acceptance Date means the date as specified in the Policy Schedule, from Benefits under the Policy during the remaining Premium Payment Term of the Policy
which the policy was effected. 23.Policy document means this document, the provided the Policy is in force as on the date of diagnosis of Permanent Disability of
Proposal Form, the Policy Schedule and any additional information/document(s) the Life Assured. b. The Policy will continue for the Death Benefit, Accidental Death
provided to Us in respect of the Proposal Form, and any endorsement issued by Us. Benefit and the Accelerated Critical Illness Benefit. c. For the purpose of this benefit, “
24.Policy Issue Date means the date as specified in the Policy Schedule. Permanent Disability” means the inability of the Life Assured to perform at least 3 of
25.Policyholder or the Proposer or You or Your means the owner of the Policy at any the following 6 activities of daily work: • Mobility: The ability to walk a distance of
point of time. 26.Policy Month refers to the period of 1 month commencing from the 200 meters on flat ground. • Bending: The ability to bend or kneel to touch the floor
Date of commencement of risk of policy and every month anniversary thereafter. and straighten up again and the ability to get into a standard saloon car, and out
27.Policy Term means the period between the Policy Acceptance Date and the Date again. • Climbing: The ability to climb up a flight of 12 stairs and down again, using
of Maturity specified in the Policy Schedule. 28. Policy Year means the period of 12 the handrail if needed. • Lifting: The ability to pick up an object weighing 2kg at table
months commencing from the Date of commencement of risk of Policy and every height and hold for 60 seconds before replacing the object on the table. • Writing:
Policy Anniversary, thereafter. 29.Policy Schedule means the policy schedule and The manual dexterity to write legibly using a pen or pencil, or type using a desktop
any endorsements attached to and forming part of this Policy. 30.Premium means personal computer keyboard. • Blindness: The permanent and irreversible loss of
the instalment premium(s) in case of Regular Pay and Limited Pay or single premium sight to the extent that even when tested with the use of visual aids, vision is
in case of Single Pay specified in the Policy Schedule which is payable/has been measured at 3/60 or worse in the better eye using a Snellen eye chart. d. Provided
received under the Policy. 31.Pre-existing Disease means any condition, ailment, that the disability should have lasted for at least 180 days without interruption from
injury or disease: i. that is/are diagnosed by a physician not more than 36 months the date of disability and must be deemed permanent by a Company empanelled
prior to the date of commencement of the policy issued by the Company or its revival Medical Practitioner. In the event of death of the insured within the above period, the
or ii. For which medical advice or treatment was recommended by, or received from, a policy shall terminate on payment of applicable benefits and all rights, benefits and
physician not more than 36 months prior to the date of commencement of the policy interests under the policy shall stand extinguished. e. In case of incidences covered
or its revival. 32.Premium Payment Term means the period specified in the Policy under accidental Permanent Disability as well as Critical Illness, benefits shall be
Schedule during which Premium is payable. 33.Proposal form means a form to be paid out under both the options.
filled in by the You in physical or electronic form, for furnishing the information 1.3 Accidental Death (AD) Benefit
including material information, if any, as required by Us in respect of a risk, in order to a. In the event of the Life Assured’s death due to an Accident, where both Accident
enable Us to take informed decision in the context of underwriting the risk, and in the and death occurs during the Accidental Death Benefit Term, the Accidental Death
event of acceptance of the risk, to determine the rates, advantages, terms and Benefit as mentioned on the Policy Schedule will be payable by Us forthwith as a
conditions of the cover to be granted. lump sum subject to the terms and conditions below. b. This is an additional benefit
Explanation: (i)“Material Information” shall mean all important, essential and relevant and will be paid in addition to the Death Benefit. c. The Accident shall result in bodily
information and documents explicitly sought by Us in the proposal form. injury or injuries to the Life Assured independently of any other means. Such injury or
34.Regulator means the authority that has regulatory jurisdiction and powers over injuries shall, within 180 days of the occurrence of the Accident, directly and
Us. Currently the Regulator is the Insurance Regulatory and Development Authority
Vishal a patil 4056
independently of any other means cause the death of the Life Assured before the
expiry of the Accidental Death Benefit term In the event of the death of the Life 2. New characteristic electrocardiogram changes
Assured after 180 days of the occurrence of the Accident, the Company shall not be 3. Elevation of infarction specific enzymes, Troponins or other specific biochemical
liable to pay the Accidental Death Benefit. The benefit will be payable if the accident markers.
occurs within the Accidental Death Benefit Term even if the death occurs beyond the The following are excluded:
Accidental Death Benefit Term (however within 180 days of the accident). d. In the
event of an accident on the Date of Maturity of Accidental Death Benefit term 1. Other acute Coronary Syndromes
resulting in the death of the Life Assured, Sum Assured for ADB shall not be 2. Any type of angina pectoris
payable. e. The Policy must be in full force at the time of Accident. f. Upon payment 3. A rise in cardiac biomarkers or Troponin T or I in absence of overt ischemic heart
of the Accidental Death Benefit, the Policy will terminate and all rights, benefits and disease OR following an intra-arterial cardiac procedure.
interests under the Policy will stand extinguished. g. In case AD Benefit is not
4. Heart Valve Surgery (Open Heart Replacement or Repair of Heart Valves):
triggered within the AD Benefit term, then AD Benefit will terminate and premiums
The actual undergoing of open-heart valve surgery is to replace or repair one or more
corresponding to it will not be payable. However You would be required to pay
heart valves, as a consequence of defects in, abnormalities of, or disease-affected
premiums for all other Benefits to keep the policy in force.
cardiac valve(s). The diagnosis of the valve abnormality must be supported by an
1.4 Accelerated Critical Illness (ACI) Benefit echocardiography and the realization of surgery has to be confirmed by a specialist
a. We shall pay the ACI Benefit upon the Life Assured being diagnosed on first medical practitioner. Catheter based techniques including but not limited to, balloon
occurrence of any of the covered 34 Critical Illnesses defined below during the ACI valvotomy/valvuloplasty are excluded.
Benefit term, provided the Policy is in force as on the date of diagnosis of Critical
5. Surgery to aorta
Illness of the Life Assured. b. Once ACI Benefit is triggered, o If ACI Benefit is less
The actual undergoing of major surgery to repair or correct an aneurysm, narrowing,
than the Death Benefit the policy will continue with a reduced Death Benefit by the
obstruction or dissection of the aorta through surgical opening of the chest or
extent of ACI Benefit paid. Premium payment on account of ACI Benefit will cease
abdomen. For the purpose of this definition, aorta shall mean the thoracic and
after payout of ACI Benefit. The future premiums for Death Benefit will reduce
abdominal aorta but not its branches.
proportionately. o If ACI Benefit is equal to the Death Benefit, then the policy will
terminate upon payment of ACI Benefit to policyholder/ Claimant as the case 6. Cardiomyopathy
maybe. o The benefit is payable irrespective of the actual expenses incurred by the An impaired function of the heart muscle, unequivocally diagnosed as
policyholder. c. In case of Angioplasty: ACI Benefit payable is subject to a maximum Cardiomyopathy by a Registered Medical Practitioner who is a cardiologist, and
of ₹. 5,00,000. On payment of this benefit for Angioplasty, o The policy will continue which results in permanent physical impairment to the degree of New York Heart
for other covered CIs with ACI Benefit reduced by Angioplasty payout and future Association classification Class III or Class IV, or its equivalent, based on the
premiums for ACI benefit shall be reduced proportionately and o The Policy will following classification criteria: Class III - Marked functional limitation. Affected
continue with Death Benefit reduced by Angioplasty payout, and future premiums for patients are comfortable at rest but performing activities involving less than ordinary
Death Benefit shall be reduced proportionately. d. In case of incidences covered exertion will lead to symptoms of congestive cardiac failure. Class IV - Inability to
under accidental Permanent Disability as well as Critical Illness, Benefits shall be carry out any activity without discomfort. Symptoms of congestive cardiac failure are
paid out under both the options. e. In the event the Life Assured is diagnosed with present even at rest. With any increase in physical activity, discomfort will be
any of the covered critical illness on the Date of Maturity of ACI term, then no ACI experienced. The Diagnosis of Cardiomyopathy has to be supported by echographic
benefit is payable. f. In case no ACI Benefit is triggered within the ACI Benefit term, findings of compromised ventricular performance. Irrespective of the above,
then ACI Benefit will terminate and premiums corresponding to it will not be payable. Cardiomyopathy directly related to alcohol or drug abuse is excluded.
However You would be required to pay premiums for all other Benefits to keep the 7. Primary (Idiopathic) Pulmonary hypertension
policy in force. An unequivocal diagnosis of Primary (Idiopathic) Pulmonary Hypertension by a
1.5 Waiting Period for Accelerated Critical Illness Benefit Cardiologist or specialist in respiratory medicine with evidence of right ventricular
a. The ACI benefit shall not apply or be payable in respect of any Critical Illness for enlargement and the pulmonary artery pressure above 30 mm of Hg on Cardiac
which care, treatment or advice was recommended by or received from a Physician, Cauterization. There must be permanent irreversible physical impairment to the
or which first manifested itself or was contracted during the first six months from the degree of at least Class IV of the New York Heart Association Classification of
date of commencement of risk or three months from the policy revival date where the cardiac impairment. The NYHA Classification of Cardiac Impairment are as follows: a.
policy has lapsed for more than three months. b. In the event of occurrence of any of Class III: Marked limitation of physical activity. Comfortable at rest, but less than
the scenarios mentioned in ‘a’ above, or in case of a death claim, where it is ordinary activity causes symptoms. b. Class IV: Unable to engage in any physical
established that the Life Assured was diagnosed to have any one of the covered activity without discomfort. Symptoms may be present even at rest. Pulmonary
critical illness during the waiting period for which a critical illness claim could have hypertension associated with lung disease, chronic hypoventilation, pulmonary
been made, the Company will refund the premiums corresponding to the ACI Benefit thromboembolic disease, drugs and toxins, diseases of the left side of the heart,
from date of commencement of risk of the policy or from the date of revival as congenital heart disease and any secondary cause are specifically excluded.
applicable and the ACI Benefit will terminate with immediate effect. c. No waiting 8. Angioplasty
period applies where the Critical Illness arises due to an Accident. For the purpose of Coronary Angioplasty is defined as percutaneous coronary intervention by way of
the ACI Benefit, “Critical Illness” means any of the following listed illnesses or balloon angioplasty with or without stenting for treatment of the narrowing or
procedures: blockage of minimum 50 % of one or more major coronary arteries. The intervention
1. Cancer of Specified Severity: must be determined to be medically necessary by a cardiologist and supported by a
A malignant tumor characterized by the uncontrolled growth and spread of coronary angiogram (CAG). Coronary arteries herein refer to left main stem, left
malignant cells with invasion and destruction of normal tissues. This diagnosis must anterior descending, circumflex and right coronary artery. Diagnostic angiography or
be supported by histological evidence of malignancy. The term cancer includes investigation procedures without angioplasty/stent insertion are excluded.
leukemia, lymphoma and sarcoma. The following are excluded – 9. Blindness
1. All tumors which are histologically described as carcinoma in situ, benign, pre- Total, permanent and irreversible loss of all vision in both eyes as a result of illness or
malignant, borderline malignant, low malignant potential, neoplasm of unknown accident. The Blindness is evidenced by: a. corrected visual acuity being 3/60 or less
behavior, or non-invasive, including but not limited to: Carcinoma in situ of breasts, in both eyes or ; b. the field of vision being less than 10 degrees in both eyes. The
Cervical dysplasia CIN-1, CIN-2 and CIN-3. diagnosis of blindness must be confirmed and must not be correctable by aids or
2. Any non-melanoma skin carcinoma unless there is evidence of metastases to surgical procedure.
lymph nodes or beyond; 10. End stage Lung Failure (Chronic Lung Disease):
3. Malignant melanoma that has not caused invasion beyond the epidermis; End stage lung disease, causing chronic respiratory failure, as confirmed and
evidenced by all of the following:
4. All tumors of the prostate unless histologically classified as having a Gleason
score greater than 6 or having progressed to at least clinical TNM classification 1. FEV1 test results consistently less than 1 litre measured on 3 occasions 3 months
T2N0M0 apart; and
5. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or 2. Requiring continuous permanent supplementary oxygen therapy for hypoxemia;
below; and
6. Chronic lymphocytic leukaemia less than RAI stage 3 3. Arterial blood gas analysis with partial oxygen pressure of 55mmHg or less (PaO2
< 55mmHg); and
7. Non-invasive papillary cancer of the bladder histologically described as TaN0M0
or of a lesser classification, 4. Dyspnea at rest.
8. All Gastro-Intestinal Stromal Tumors histologically classified as T1N0M0 (TNM 11. End stage liver failure (Chronic Liver Disease):
Classification) or below and with mitotic count of less than or equal to 5/50 HPFs; Permanent and irreversible failure of liver function that has resulted in all three of the
following:
2. Open Chest CABG:
The actual undergoing of heart surgery to correct blockage or narrowing in one or 1. Permanent jaundice; and
more coronary artery(s), by coronary artery bypass grafting done via a sternotomy 2. Ascites; and
(cutting through the breast bone) or minimally invasive keyhole coronary artery 3. Hepatic encephalopathy.
bypass procedures. The diagnosis must be supported by a coronary angiography Liver failure secondary to drug or alcohol abuse is excluded.
and the realization of surgery has to be confirmed by a cardiologist. Excluded
are: Angioplasty and/or any other intra-arterial procedures 12. Kidney Failure Requiring Regular Dialysis:
End stage renal disease presenting as chronic irreversible failure of both kidneys to
3. Myocardial Infarction (First Heart Attack of Specified Severity):
function, as a result of which either regular renal dialysis (hemodialysis or peritoneal
The first occurrence of heart attack or myocardial infarction, which means the death dialysis) is instituted or renal transplantation is carried out. Diagnosis has to be
of a portion of the heart muscle as a result of inadequate blood supply to the confirmed by a specialist medical practitioner.
relevant area. The diagnosis for Myocardial Infarction should be evidenced by all of
the following criteria: 13. Major Organ/ Bone Marrow Transplant
The actual undergoing of a transplant of: i. One of the following human organs:
1. A history of typical clinical symptoms consistent with the diagnosis of acute
myocardial infarction (For e.g. typical chest pain) Vishal a patil 4056
heart, lung, liver, kidney, pancreas, that resulted from irreversible end-stage failure of
the relevant organ, or ii. Human bone marrow using haematopoietic stem cells. The of care staff due to the disease. This must be medically documented for a period of at
undergoing of a transplant has to be confirmed by a specialist medical least 90 days The following conditions are however not covered: a. neurosis or
practitioner. iii. The following are excluded: a. Other stem-cell transplants b. Where neuropsychiatric symptoms without imaging evidence of Alzheimer’s Disease b.
only islets of langerhans are transplanted alcohol related brain damage; and c. any other type of irreversible organic disorder/
14. Apallic Syndrome: dementia not associated with Alzheimer’s Disease The Activities of Daily Living are: i.
Universal necrosis of the brain cortex, with the brain stem intact. Diagnosis must be Washing: the ability to wash in the bath or shower (including getting into and out of
definitely confirmed by a Registered Medical practitioner who is also a neurologist the bath or shower) or wash satisfactorily by other means; ii. Dressing: the ability to
holding such an appointment at an approved hospital. This condition must be put on, take off, secure and unfasten all garments and, as appropriate, any braces,
documented for at least one (1) month. artificial limbs or other surgical appliances; iii. Transferring: the ability to move from a
bed to an upright chair or wheelchair and vice versa; iv. Mobility: the ability to move
15. Benign Brain Tumour: indoors from room to room on level surfaces; v. Toileting: the ability to use the
Benign brain tumor is defined as a life threatening, non-cancerous tumor in the brain, lavatory or otherwise manage bowel and bladder functions so as to maintain a
cranial nerves or meninges within the skull. The presence of the underlying tumor satisfactory level of personal hygiene; vi. Feeding: the ability to feed oneself once
must be confirmed by imaging studies such as CT scan or MRI. This brain tumor must food has been prepared and made available
result in at least one of the following and must be confirmed by the relevant medical
22. Motor Neurone Disease with permanent symptoms
specialist.
Motor neurone disease diagnosed by a specialist medical practitioner as spinal
1. Permanent Neurological deficit with persisting clinical symptoms for a continuous muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis or primary
period of at least 90 consecutive days or lateral sclerosis. There must be progressive degeneration of corticospinal tracts and
2. Undergone surgical resection or radiation therapy to treat the brain tumor. anteriorhorn cells or bulbar efferent neurons. There must be current significant and
The following conditions are excluded: Cysts, Granulomas, malformations in the permanent functional neurological impairment with objective evidence of motor
arteries or veins of the brain, hematomas, abscesses, pituitary tumors, tumors of skull dysfunction that has persisted for a continuous period of at least 3 months.
bones and tumors of the spinal cord. 23. Multiple Sclerosis with Persisting Symptoms
16. Brain Surgery The unequivocal diagnosis of Definite Multiple Sclerosis confirmed and evidenced by
The actual undergoing of surgery to the brain, under general anaesthesia, during all of the following:
which a Craniotomy is performed. Burr hole and brain surgery as a result of an 1. investigations including typical MRI findings which unequivocally confirm the
accident is excluded. The procedure must be considered necessary by a qualified diagnosis to be multiple sclerosis and
specialist and the benefit shall only be payable once corrective surgery has been
2. there must be current clinical impairment of motor or sensory function, which must
carried out.
have persisted for a continuous period of at least 6 months.
17. Coma of Specified Severity: Other causes of neurological damage such as SLE are excluded.
A state of unconsciousness with no reaction or response to external stimuli or
24. Muscular Dystrophy
internal needs. This diagnosis must be supported by evidence of all of the following: •
no response to external stimuli continuously for at least 96 hours; • life support Diagnosis of muscular dystrophy by a Registered Medical Practitioner who is a
measures are necessary to sustain life; and • permanent neurological deficit which neurologist based on three (3) out of four (4) of the following conditions: (a) Family
must be assessed at least 30 days after the onset of the coma The condition has to history of other affected individuals; (b) Clinical presentation including absence of
be confirmed by a specialist medical practitioner. Coma resulting directly from alcohol sensory disturbance, normal cerebro-spinal fluid and mild tendon reflex reduction; (c)
or drug abuse is excluded. Characteristic electromyogram; or (d) Clinical suspicion confirmed by muscle
biopsy. The condition must result in the inability of the Life Assured to perform
18. Major Head Trauma (whether aided or unaided) at least three (3) of the six (6) ‘Activities of Daily Living’
Accidental head injury resulting in permanent Neurological deficit to be assessed no as defined, for a continuous period of at least six (6) months.
sooner than 3 months from the date of the accident. This diagnosis must be
25. Parkinson’s Disease
supported by unequivocal findings on Magnetic Resonance Imaging, Computerized
Tomography, or other reliable imaging techniques. The accident must be caused Unequivocal Diagnosis of Parkinson’s Disease by a Registered Medical Practitioner
solely and directly by accidental, violent, external and visible means and who is a neurologist where the condition: (a) cannot be controlled with medication;
independently of all other causes. The Accidental Head injury must result in an (b) shows signs of progressive impairment; and (c) Activities of Daily Living
inability to perform at least three (3) of the following Activities of Daily Living either assessment confirms the inability of the Insured to perform at least three (3) of the
with or without the use of mechanical equipment, special devices or other aids and Activities of Daily Living as defined in the Policy, either with or without the use of
adaptations in use for disabled persons. For the purpose of this benefit, the word mechanical equipment, special devices or other aids or adaptations in use for
“permanent” shall mean beyond the scope of recovery with current medical disabled persons. Drug-induced or toxic causes of Parkinson’s disease are
knowledge and technology. The Activities of Daily Living are: excluded.

1. Washing: the ability to wash in the bath or shower (including getting into and out 26. Poliomyelitis
of the bath or shower) or wash satisfactorily by other means; The occurrence of Poliomyelitis where the following conditions are met:
2. Dressing: the ability to put on, take off, secure and unfasten all garments and, as 1. Poliovirus is identified as the cause and is proved by Stool Analysis,
appropriate, any braces, artificial limbs or other surgical appliances; 2. Paralysis of the limb muscles or respiratory muscles must be present and persist
3. Transferring: the ability to move from a bed to an upright chair orwheelchair and for at least 3 months.
vice versa;
4. Mobility: the ability to move indoors from room to room on level surfaces; 27. Loss of Independent Existence
5. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder The insured person is physically incapable of performing at least three (3) of the
functions so as to maintain a satisfactory level of personal hygiene; “Activities of Daily Living” as defined below (either with or without the use of
mechanical equipment, special devices or other aids or adaptations in use for
6. Feeding: the ability to feed oneself once food has been prepared and made disabled persons) for a continuous period of at least six (6) months, signifying a
available. permanent and irreversible inability to perform the same. For the purpose of this
The following are excluded: definition, the word “permanent” shall mean beyond the hope of recovery with
1. Spinal cord injury; current medical knowledge and technology. The Diagnosis of Loss of Independent
19. Permanent Paralysis of Limbs Existence must be confirmed by a Registered Doctor Who is a specialist. Only Life
Total and irreversible loss of use of two or more limbs as a result of injury or disease Insured with Insurance Age between 18 and 74 on first diagnosis is eligible to receive
of the brain or spinal cord. A specialist medical practitioner must be of the opinion a benefit under this illness. Activities of Daily Living:
that the paralysis will be permanent with no hope of recovery and must be present 1. Washing: the ability to wash in the bath or shower (including getting into and out
for more than 3 months. of the bath or shower) or wash satisfactorily by other means;
20. Stroke resulting in permanent symptoms 2. Dressing: the ability to put on, take off, secure and unfasten all garments and, as
Any cerebrovascular incident producing permanent neurological sequelae. This appropriate, any braces, artificial limbs or other surgical appliances;
includes infarction of brain tissue, thrombosis in an intracranial vessel, haemorrhage 3. Transferring: the ability to move from a bed to an upright chair or wheelchair and
and embolisation from an extracranial source. Diagnosis has to be confirmed by a vice versa;
specialist medical practitioner and evidenced by typical clinical symptoms as well as 4. Mobility: the ability to move indoors from room to room on level surfaces;
typical findings in CT Scan or MRI of the brain. Evidence of permanent neurological
deficit lasting for at least 3 months has to be produced. The following are excluded: • 5. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder
Transient ischemic attacks (TIA) • Traumatic injury of the brain • Vascular disease functions so as to maintain a satisfactory level of personal hygiene;
affecting only the eye or optic nerve or vestibular functions. 6. Feeding: the ability to feed oneself once food has been prepared and made
21. Alzheimer's Disease available.
Alzheimer’s (presenile dementia) disease is a progressive degenerative disease of 28. Loss of Limbs
the brain, characterised by diffuse atrophy throughout the cerebral cortex with The physical separation of two or more limbs, at or above the wrist or ankle level
distinctive histopathological changes. It affects the brain, causing symptoms like limbs as a result of injury or disease. This will include medically necessary
memory loss, confusion, communication problems, and general impairment of mental amputation necessitated by injury or disease. The separation has to be permanent
function, which gradually worsens leading to changes in personality. Deterioration or without any chance of surgical correction. Loss of Limbs resulting directly or indirectly
loss of intellectual capacity, as confirmed by clinical evaluation and imaging tests, from self-inflicted injury, alcohol or drug abuse is excluded.
arising from Alzheimer’s disease, resulting in progressive significant reduction in 29. Deafness
mental and social functioning, requiring the continuous supervision of the Insured Total and irreversible loss of hearing in both ears as a result of illness or accident.
Person. The diagnosis must be supported by the clinical confirmation of a Neurologist This diagnosis must be supported by pure tone audiogram test and certified by an
and supported by Our appointed Medical Practitioner. The disease must result in a Ear, Nose and Throat (ENT) specialist. Total means “the loss of hearing to the extent
permanent inability to perform three or more Activities of daily living with Loss of
Independent Living” or must require the need of supervision and permanent presence Vishal a patil 4056
that the loss is greater than 90decibels across all frequencies of hearing” in both 20 5% 0.41667%
ears.
30 3.33% 0.27778%
30. Loss of Speech
Total and irrecoverable loss of the ability to speak as a result of injury or disease to The Claimant can also advance the first year’s income as lump sum. In such case,
the Vocal Cords. The inability to speak must be established for a continuous period of the monthly income payable to the claimant (in equal monthly instalments) shall be
12 months. This diagnosis must be supported by medical evidence furnished by an arrived at a different rate as mentioned below and payment shall commence from
Ear, Nose, and Throat (ENT) specialist. the subsequent month for the remaining Income Term (total income term less 1
31. Medullary Cystic Disease year). The income term wise benefit amount payable is given below:
Medullary Cystic Disease where the following criteria are met: a) the presence in the Income Term (in % of Death Benefit payable monthly if year 1 benefit is taken as
kidney of multiple cysts in the renal medulla accompanied by the presence of tubular years) lumpsum
atrophy and interstitial fibrosis; b) clinical manifestations of anaemia, polyuria, and 10 0.80%
progressive deterioration in kidney function; and c) the Diagnosis of Medullary Cystic
Disease is confirmed by renal biopsy. Isolated or benign kidney cysts are specifically 20 0.40%
excluded from this benefit. 30 0.27%
32. Systematic lupus Eryth. with Renal Involvement
Multi-system, autoimmune disorder characterized by the development of auto- 3. Lump sum and Income – The total amount payable on earlier of death or terminal
antibodies, directed against various self-antigens. For purposes of the definition of illness under this option will be equal to the Death Benefit reduced by ACI benefit
“Critical Illness”, SLE is restricted to only those forms of systemic lupus paid, if any. In this the Death Benefit will be paid as a combination of income and
erythematosus, which involve the kidneys and are characterized as Class III, Class IV, lump sum payout options. The part of the Death Benefit amount to be paid out as
Class V or Class VI lupus nephritis under the Abbreviated International Society of lump sum is chosen at inception. The balance Death Benefit amount will be paid out
Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus nephritis in equal monthly instalments in advance at a defined rate of death benefit for the
(2003) below based on renal biopsy. Other forms such as discoid lupus, and those Income Term chosen at inception given under Clause 1.6 (2) above.
forms with only hematological and joint involvement are specifically 4. Increasing Income Option – Benefit amount is payable in monthly instalments for
excluded. Abbreviated ISN/RPS classification of lupus nephritis (2003): Class I - 10 years starting with 10% of the benefit amount per annum in the first year. The
Minimal mesangial lupus nephritis Class II - Mesangial proliferative lupus income amount will increase at 10% p.a. simple interest every year thereafter. Sum
nephritis Class III - Focal lupus nephritis Class IV - Diffuse segmental (IV-S) or global of total monthly benefits payable over 10 years is equal to 145% of the (death
(IV-G) lupus nephritis Class V - Membranous lupus nephritis ClassVI - Advanced benefit amount reduced by ACI benefit paid), if any.
sclerosing lupus nephritis the final diagnosis must be confirmed by a certified doctor For options 2, 3, and 4,.at the time of death claim approval or at any time after the
specialising in Rheumatology and Immunology. start of monthly income, the Claimant will have the option to convert the outstanding
33. Third degree burns (Major Burns): monthly income into lump sum pay out. The Policy will terminate with all rights and
There must be third-degree burns with scarring that cover at least 20% of the body’s benefits after the lump sum payout has been released to the Claimant. The lump sum
surface area. The diagnosis must confirm the total area involved using standardized, amount will be the present value of future payouts calculated at a discount rate as
clinically accepted, body surface area charts covering 20% of the body surface area. given below: • At the time of death claim approval: 4% p.a. At any time after the
payment of first monthly income: Higher of 4% and 10-year Government Securities
34. Aplastic Anaemia
yield, rounded to nearest 0.25%. The yield on 10-year Government Securities will be
Irreversible persistent bone marrow failure which results in anaemia, neutropenia sourced from www.bloomberg.com. This discount rate will be reviewed twice every
and thrombocytopenia requiring treatment with at least two (2) of the following: (a) year on 1st of June and 1st of December.
Blood product transfusion; (b) Marrow stimulating agents; (c) Immunosuppressive
1.8 Smart Exit Benefit
agents; or (d) Bone marrow transplantation. The Diagnosis of aplastic anaemia must
be confirmed by a bone marrow biopsy. Two out of the following three values should You have an option to cancel the Policy and avail the below benefits: i. Base Benefit –
be present: - Absolute Neutrophil count of 500 per cubic millimetre or less; - Absolute If this option is exercised, You will receive an amount equal to the Total Premiums
Reticulocyte count of 20,000 per cubic millimetre or less; and - Platelet count of Paid* under the Policy ii. Additional Benefit – If this option is availed in the (T-10)th
20,000 per cubic millimetre or less. Policy year, where T is the Policy Term, then in furtherance to the Base Benefit, You
will receive an additional amount equal to the Total Premiums Paid* under the policy.
1.6 Life Stage Protection
This additional benefit is available only under Limited Pay policies with Premium
If Your policy is a Regular pay policy, You can choose to increase the Sum Assured at Payment Terms of 5 years, 7 years, 10 years and 15 years. For example, if the
the key milestones of Life Assured such as marriage and child birth/ adoption of Premium Payment Term is 10 years, Policy Term is 40 years and cancellation of the
child, provided no claim has been admitted for any benefits under the policy and the
policy has been availed in the 30th Policy Year, the policyholder is eligible to receive
policy is in force. The Sum Assured can be increased without any medicals on any
200% of Total Premiums Paid* as the total payout upon cancellation. The Smart Exit
one or all of the below events during the Policy Term to the extent as mentioned
Benefit shall become payable subject to the fulfillment of all the below mentioned
below..
conditions: i. This option can be exercised in any policy year greater than 29 but not
Additional Sum Assured (percentage of Subject to maximum during the last 5 policy years. ii. The age of the life assured is 60 years or more at the
Event
original Sum Assured) additional Sum Assured time of exercise. iii. The policy is in-force with all due premiums paid at the time of
Marriage 50% ₹ 50,00,000 exercising this option. iv. No claim for any of the underlying benefits has been
Birth / Legal adoption registered and is under evaluation/ accepted/ or paid/being paid on the policy. The
25% ₹ 25,00,000
of 1st child Policy shall terminate on payment of this benefit (if exercised) and all rights, benefits
Birth / Legal adoption and interests under this Policy will stand extinguished. You can either opt for Smart
25% ₹ 25,00,000 Exit Benefit or Unexpired Risk Premium Value as per Clause 3, Part D, i.e. both the
of 2nd child
Smart Exit Benefit and Surrender Benefit cannot be availed simultaneously.
This feature is available only to a Life Assured underwritten as a standard life *For Smart Exit benefit: Total Premiums Paid shall exclude the additional premiums
without any extra premium at inception On exercising this option, You will have to paid for Accelerated Critical Illness and Accidental Death Benefits. Where Life Stage
pay an additional premium for the additional Sum Assured for the outstanding term Protection options has been exercised, Total Premiums Paid shall include the
of the policy based on the life assured’s age at the time of availing this option. Hence Premiums paid for each tranche of additional Sum Assured purchased.
the future premium payable by You on exercising this option will be the sum of
2. Premium payment:
original premium and additional premium including applicable taxes. Such an
i. You are required to pay Premium instalments (including taxes) on the due dates for
increase in sum assured is only applicable to base Sum Assured The ACI Benefit and
the amount mentioned in the Policy Schedule and for the entire Premium Payment
AD Benefit will remain unchanged. Upon opting for this feature, Your Premium will be
Term. ii. If any instalment premium is not paid within the Grace Period then the Policy
recalculated based on the increased Sum Assured and outstanding policy term. This
shall lapse and all cover under the Policy will cease. iii. If Single Pay option has been
is subject to:
chosen by You, only one Premium is to be paid and no future Premiums are
1. Minimum policy term (which is 5 years) available at the time of exercising this payable. iv. The loading based on premium paying modes are mentioned below:
feature.
Premium frequency Loading as a % of Premium
2. Life Assured being less than 50 years of age at the time of the event.
Yearly NA
3. Total Sum Assured that can be increased under this feature cannot exceed the
Half-yearly 1.25%
maximum additional sum assured mentioned in the table above.
Such increase in Sum Assured needs to be exercised within 6 months of the event Monthly 2.50%
and will be effective with payment of additional regular premium from the next Policy
Anniversary. v. You may pay Premium through any of the following modes: a) Cheque b) Demand
Draft c) Pay Order d) Banker’s cheque e) Internet facility as approved by the
1.7 Death Benefit Payout Options
Company from time to time f) Electronic Clearing System / Direct Debit g) Credit or
The Death Benefit will be payable to the Claimant as per one of the below options Debit cards held in your name vi. Amount and modalities will be subject to our rules
chosen by You at the inception of Your policy and mentioned in Your Policy Schedule. and relevant legislation or regulation vii. Any payment made towards first or renewal
1. Lump Sum Option – Entire Death Benefit amount is payable as lump sum. premium is deemed to be received by Us only when it is received at any of Our
2. Income Option – A percentage of the Death Benefit amount is payable every year branch offices or authorized collection points and after an official printed receipt is
throughout the Income term. This will be payable in equal monthly instalments in issued by Us. viii. No person or individual or entity is authorized to collect cash or self-
advance at a defined rate of death benefit amount given in the table below: cheque or bearer cheque on Our behalf. ix. Cheque or demand drafts must be drawn
The income term wise benefit amount payable is given below: only in favour of ICICI Prudential Life Insurance Company Limited. x. Please ensure
that You mention the application number for the first premium deposit and the policy
Income Term (in % of Death Benefit payable % of Death Benefit payable monthly in number for the renewal premiums on the cheque or demand draft. xi. In the event,
years) every year advance
first premium deposit or renewal premium is being paid You via online/ internet
10 10% 0.83333% banking then please mention the application number or policy number as applicable
Vishal a patil 4056
in the comment section during the transaction. xii. Where Premiums have been
remitted otherwise than in cash, the application of the Premiums received will be 5.2 For Accidental Death Benefit the following exclusions apply:
conditional on the realization of the proceeds of the instrument of payment, including We will not be liable to pay the Accidental Death Benefit if the Accident is directly or
electronic mode. xiii. In case the payment made towards the first premium or renewal indirectly due to or caused, occasioned, accelerated or aggravated by, any one of the
premium is not realized by us due to any reason whatsoever you shall be solely following: a) Attempted suicide or self-inflicted injuries while sane or insane, or whilst
responsible for the verification of such realisation. xiv. In case the payment made the Life Assured is under the influence of any narcotic substance or drug or
towards the first Premium is not realised by us due to any reason whatsoever, the intoxicating liquor except under the direction of a medical practitioner; or b)
Policy, if issued, shall stand automatically cancelled. xv. If You suspend payment of Engaging in aerial flights (including parachuting and skydiving) other than as a fare
premium for any reason whatsoever, We will not be held liable. In such an event, paying passenger or crew on a licensed passenger-carrying commercial aircraft
benefits, if any, will be available only in accordance with the Policy terms and operating on a regular scheduled route; or c) The Life Assured with criminal intent,
conditions. . committing any breach of law; or d) Due to war, whether declared or not or civil
3. Maturity/Survival Benefit: commotion; or e) Engaging in hazardous sports or pastimes, e.g. taking part in (or
No benefit will be payable upon survival of the Life Assured at the completion of the practising for) boxing, caving, climbing, horse racing, jet skiing, martial arts,
policy term . On the Date of Maturity, the Policy will automatically stand terminated mountaineering, off piste skiing, pot holing, power boat racing, underwater diving,
with all rights, benefits and interests thereunder yacht racing or any race, trial or timed motor sport.
4. Grace Period 5.3 For ACI Benefit the following exclusions apply:
If you are unable to pay an instalment premium by the due date, you will be given a We will not be liable to pay any ACI Benefit in respect of any listed condition arising
grace period of 15 days for payment of due instalment premium if You have chosen directly or indirectly from, though, in consequence of or aggravated by any of the
monthly frequency, and 30 days for payment of due instalment premium if You have following: a) Pre-Existing Conditions or conditions connected to a Pre-Existing
chosen any other frequency, commencing from the premium due date. The life cover Condition will be excluded. Pre-existing Disease means any condition, ailment, injury
continues during the grace period. In case of death or diagnosis of terminal illness of or disease: i. that is/are diagnosed by a physician not more than 36 months prior to
Life Assured during the grace period, We will pay the applicable Death Benefit. In the date of commencement of the policy issued by the Company or its revival or ii. For
case of death of Life Assured due to accident during the grace period, applicable which medical advice or treatment was recommended by, or received from, a
Accidental Death Benefit will be payable. In case of diagnosis of critical illness of Life physician not more than 36 months prior to the date of commencement of the policy
Assured during the grace period, applicable Accelerated Critical Illness benefit will be or its revival. b) Existence of any Sexually Transmitted Disease (STD) and its related
payable. Grace period is applicable for Regular Pay and Limited Pay only. complications c) Self-inflicted injury, suicide, insanity and deliberate participation of
the life insured in an illegal or criminal act with criminal intent. d) Use of intoxicating
5.Renewal Premium in Advance:
drugs / alcohol / solvent, taking of drugs except under the direction of a qualified
a)Collection of renewal premium in advance shall be allowed within the same medical practitioner. e) War – whether declared or not, civil commotion, breach of
financial year for the premium due in that financial year. Provided, the premium due law with criminal intent, invasion, hostilities (whether war is declared or not),
in one financial year may be collected in advance in earlier financial year for a rebellion, revolution, military or usurped power or wilful participation in acts of
maximum period of three months in advance of the due date of the premium. b)The violence. f) Aviation other than as a fare paying passenger or crew in a commercial
renewal premium so collected in advance shall only be adjusted on the due date of licensed aircraft. g) Taking part in any act of a criminal nature with criminal intent. h)
the premium. Treatment for injury or illness caused by avocations / activities such as hunting,
PART-D mountaineering, steeple-chasing, professional sports, racing of any kind, scuba
1. Free look Period (30 days refund policy) diving, aerial sports, activities such as hand-gliding, ballooning, deliberate exposure
On receipt of the policy document whether received electronically or otherwise, You to exceptional danger. i) Radioactive contamination due to nuclear accident. j)
have an option to review the policy terms and conditions. If You are not satisfied or Failure to seek or follow medical advice, the Life assured has delayed medical
have any disagreement with the terms and conditions of the policy or otherwise and treatment in order to circumvent the waiting period or other conditions and
has not made any claim, the policy document needs to be returned to the Company restriction applying to this policy. k) Any treatment of a donor for the replacement of
with reasons for cancellation within 30 days from the date of receipt of the policy an organ. l) Any illness due to a congenital defect or disease which has manifested or
document. On cancellation of the Policy during the freelook period, We will return the was diagnosed before the Insured attains aged 17.
premium paid subject to the following deductions: i. Proportionate risk premium for 6. Loan
the period of cover ii. Stamp duty under the Policy iii. Expenses borne by the We will not provide loans under this Policy.
Company on medical examination, if any The Policy shall terminate on payment of 7. Riders
this amount and all rights, benefits and interests under this Policy will stand
Riders may be offered but only subject to prior approval of the Regulator.
extinguished.
8. Revival
2. Paid-up Value
A Policy which has lapsed for non-payment of premium within the grace period may
There is no paid-up value under this Policy.
be revived subject to underwriting and the following conditions: a) The application for
3. SurrenderOn policy surrender, Surrender Value equal to Unexpired risk premium revival is made within 5 years from the due date of the first unpaid premium and
value will be payable to the You: before the Date of Maturity of the Policy. Revival will be based on the prevailing
• Single Pay Unexpired risk premium value = 25% X [1 – (Policy Month of surrender – Board approved underwriting policy. b) You furnish, at your own expense,
1)/ (Policy Term X 12)] X Total Premiums Paid. • Limited Pay o If one full year’s satisfactory evidence of health as required by Us. c) The arrears of Premiums
premium is not paid, Unexpired risk premium value = 0. o If one full year’s premium together with interest at such rate as We may charge for late payment of premiums
has been paid, then the Unexpired risk premium value = 25% X [Number of months are paid. Revival interest rates will be set monthly and is equal to 1.50% plus the
for which premiums are paid / (Premium Payment Term X 12)] X [1 – (Policy Month of prevailing yield on 10 year Government Securities. The yield on 10 year Government
surrender – 1)/ (Policy Term X 12)] X Total Premiums Paid. • Regular Pay Unexpired Securities will be sourced from www.bloomberg.com.The interest rate applicable in
risk premium value = 0 February 2025 is 8.21% p.a. compounded half yearly. d) The revival interest rate will
4.Lapse be reviewed on the 15th day of every month by the Company based on the 10-year
If any premium instalment is not paid within the grace period, then the Policy shall G-Sec yield of one day prior to such review. e) The revival of the Policy may be on
lapse, and the cover will cease. If the Policy is not revived within the Revival Period, terms different from those applicable to the Policy before it lapsed for example, extra
then the Surrender Value (if applicable ,computed as on date of premium mortality premiums or charges may be applicable subject to our Board approved
discontinuance), if any, shall become payable on the earliest of the following events: • underwriting policy. f) We reserve the right to not revive the Policy. In that case, only
Event of death or diagnosis of terminal illness (whichever happens first) of the Life the premiums paid towards the revival of the Policy shall be refunded without any
Assured within the Revival Period, • End of the Revival Period, and • Date of interest. g) For ACI Benefit, a waiting period of 3 months will be applicable for any
Maturity Post payment of such surrender value (if any), then the policy shall foreclose revivals after 3 months from the due date of the first unpaid premium. No waiting
and all rights and benefits under the policy shall stand extinguished. period will be applicable for any revival within 3 months of the due date of the first
unpaid premium. h) The revival will take effect only if it is specifically communicated
5. Exclusions
by Us to You i) On revival of a lapsed policy, the lower of the Sum Assured as
5.1 For Waiver of Premium on Permanent Disability due to accident the following applicable on the date of premium discontinuance or as approved during revival
exclusions shall apply: (following Board Approved Underwriting policy) shall be restored.
i. We will not be liable to provide the Waiver of Premium on Permanent Disability
9. To whom benefits are payable
benefit if the Permanent Disability is directly or indirectly due to or caused,
Benefits are payable to the Policyholder or to the Assignee(s), nominee where an
occasioned, accelerated or aggravated by, any one of the following: • Attempted
endorsement has been recorded in accordance with Section 38 and Section 39 of the
suicide or self-inflicted injuries while sane or insane, or whilst the Life Assured is
Insurance Act, 1938 as may be applicable. If the Policyholder and the Life Assured
under the influence of any narcotic substance or drug or intoxicating liquor except
are different, then in the event of death of the Policyholder and upon subsequent
under the direction of a medical practitioner; or • Engaging in aerial flights (including
intimation of the death with the Company, the policy shall vest on the Life Assured.
parachuting and skydiving) other than as a fare paying passenger or crew on a
Thereafter, the Life Assured shall become the Policyholder and will be entitled to all
licensed passenger-carrying commercial aircraft operating on a regular scheduled
benefits and subject to all liabilities as per the terms and conditions of the policy. The
route; or • The Life Assured with criminal intent committing any breach of law; or •
Life Assured cum Policyholder can register due nomination as per Section 39 of the
Due to war, whether declared or not or civil commotion; or • Engaging in hazardous
Insurance Act, 1938 as amended from time to time. We hereby agree to pay the
sports / pastimes, i.e. taking part in (or practising for) boxing, caving, climbing, horse
appropriate benefits under the Policy subject to: a) Our satisfaction of the benefits
racing, jet skiing, martial arts, mountaineering, off piste skiing, pot holing, power boat
having become payable on the happening of an event as per the Policy terms and
racing, underwater diving, yacht racing or any race, trial or timed motor sport. • PD
conditions, b) The title of the said person or persons claiming payment,
due to accident must be caused by violent, external and visible means. ii. The
accident shall result in bodily injury or injuries to the Life Assured independently of PART-E
any other means. Such injury or injuries shall, within 180 days of the occurrence of Not Applicable
the accident, directly and independently of any other means cause the PD of the Life PART-F
Assured. In the event of PD of the Life Assured after 180 days of the occurrence of General Conditions
the accident, the Company shall not be liable to pay this benefit. iii. The Company 1. Age We have issued this policy considering the date of birth of the Life Assured as
shall not be liable to pay this benefit in case PD of the Life Assured occurs on or after declared by You in the proposal form to be true and correct. However, if at any point
the Date of Maturity of the policy. Vishal a patil 4056
of time it is found that the age of the Life Assured as declared in the proposal form is
different from the actual Age of the Life Assured, then the Company reserves the For any clarification or assistance, You may submit your query or request through
right to cancel the policy. ‘write to us’ section on our mobile app or website. You may contact Our advisor or
2. Nomination Nomination under the Policy will be governed by Section 39 of the call Our customer service representative (between 10.00 a.m. to 7.00 p.m, Monday to
Insurance Act, 1938, as amended from time to time. Please refer to Annexure I for Saturday; excluding national holidays) on the numbers mentioned in the policy
details on this section. document or on Our website: www.iciciprulife.com. For our NRI customers or any
3. Assignment Assignment of the Policy will be governed by Section 38 of the claim related assistance or enquiries, you can call us 24*7 on the numbers specified
Insurance Act, 1938, as amended from time to time. Please refer to Annexure II for in the policy document or on Our website: www.iciciprulife.com except on national
details on this section. holidays. Additionally, you can touch base with us through chat and WhatsApp for a
4. Incontestability Incontestability will be as per Section 45 of the Insurance Act, host of servicing enquiries or request submissions. Alternatively, You may
1938, as amended from time to time. Please refer to Annexure III for details on this communicate with Us at any of our branches or the customer service desk whose
section. details are mentioned in the policy document. For updated contact details, we
5. Misstatement & Fraud Misstatement and Fraud will be as per Section 45 of the request You to regularly check Our website.
Insurance Act, 1938, as amended from time to time. Please refer to Annexure III for i.Grievance Redressal Officer:
details on this section. The Policy is subject to the terms and conditions as mentioned If You do not receive any resolution from Us or if You are not satisfied with Our
in the Policy document and is governed by the Laws of India. resolution, You may submit your concern to the designated grievance redressal
6. Communication address Our communication address is: Address: Customer officer (GRO) at the ‘grievance redressal’ section on our website, or write to us at
Service Desk ICICI Prudential Life Insurance Company Limited, Unit 901A & 901B, at [email protected] . Alternatively, you may send a letter at the communication
9th Floor, Prism Towers Mindspace Link Road, Goregaon West,Mumbai- 400063, address mentioned below Address: ICICI Prudential Life Insurance Company
Maharashtra. Telephone: 1800-2660 Facsimile: 022 4205 8222 E-mail: Limited, Unit 901A & 901B, 9thFloor, Prism Towers Mindspace Link Road, Goregaon
[email protected] We expect You to immediately inform Us about any change in West, Mumbai-400063
Your address or contact details.
7. Electronic transactions All transactions carried out by You through Internet, ii.Grievance Redressal Committee:
electronic, call centres, tele-service operations, computer, automated machines If You do not receive any resolution or if You are not satisfied with the resolution
network or through other means of communication will be valid and legally binding provided by the GRO, You may escalate the matter to Our internal grievance
on Us as well as You. This will be subject to the relevant guidelines and terms and redressal committee at the ‘grievance redressal’ section on our website or write a
conditions as may be specified by Us. letter at the address mentioned below: ICICI Prudential Life Insurance Co. Ltd. Unit
8. Jurisdiction The Policy is subject to the terms and conditions as mentioned in the 901A & 901B, 9thFloor, Prism Towers Mindspace Link Road, Goregaon
Policy document and is governed by the laws of India. Indian courts shall have West, Mumbai- 400063
exclusive jurisdiction over all differences or disputes arising in relation to this Policy. Maharashtra.
9. Legislative changes All benefits payable under the Policy are subject to the tax iii.Policyholders’ Protection and Grievance Redressal Department:
laws and other financial enactments as they exist from time to time. The Policy terms If you are not satisfied with the response or do not receive a response from us within
and conditions may be altered based on any future legislative or regulatory changes. two weeks, you may approach Policyholders’ Protection and Grievance Redressal
10. Payment of claim For processing a death claim, we require the following Department, the Grievance Cell of the Insurance Regulatory and Development
mandatory documents • Duly filled and signed Claimant Statement Form • Copy of Authority of India (IRDAI) on the following contact details:
Death Certificate of the Life Assured, issued by government authority • Claimant
IRDAI Grievance Call Centre (BIMA BHAROSA SHIKAYAT NIVARAN KENDRA)
address proof* • Claimant photo identity proof* • Recent photograph of the
claimant • Pan card / Form 60 of the claimant • Duly filled and signed Payout 155255 (or) 1800 4254 732
mandate form with bank account details of the claimant • Copy of cancelled cheque / Email ID: [email protected]
bank statement / bank passbook with printed account number and name of the You can also register your complaint online atbimabharosa.irdai.gov.in
claimant DOCUMENTS REQUIRED BASED ON CAUSE OF DEATH A. In case of Address for communication for complaints by fax/paper: Policyholders’ Protection
death due to Unnatural causes such as Accidents (Road / Rail / Air etc), Murder, and Grievance Redressal Department – Grievance Redressal Cell Insurance
Suicide, etc. • Medico-legal cause of death certificate • First Information Report (FIR) Regulatory and Development Authority of India Survey No. 115/1, Financial District,
from the police authority • Inquest/ Panchnama Report • Final police investigation Nanakramguda, Gachibowli, Hyderabad, Telangana State – 500032
report • Post Mortem Report (PMR) issued by the hospital • Viscera / Chemical
Insurance Ombudsman:
examination report • Newspaper Cutting, if any • Driving License (of the Life Assured
The Central Government has established an office of the Insurance Ombudsman for
driving the vehicle in case of death due to a road accident) • Hospitalization /
redressal of grievances with respect to life insurance policies. As per Insurance
treatment records if any • Duly filled in Medical/ Hospital Attendant Certificate • Duly
Ombudsman Rules, 2017 and Insurance Ombudsman (Amendment) Rules, 2021, the
filled in Employer Certificate (only if Life Assured was a salaried individual) B. In Case
Ombudsman shall receive and consider complaints or alleging deficiency in
of death due to Natural or medical causes (death at home, hospital ) • Medico-
performance required of an insurer (including its agents and intermediaries) or an
legal / Medical cause of death certificate • Past medical records and treatment
insurance broker, on any of the following grounds: a.delay in settlement of claims,
papers • All hospitalization records of the Life Assured such as: i. Admission form ii.
beyond the time specified in the regulations, framed under the Insurance Regulatory
Indoor Case Papers (ICPs) iii. Discharge summary iv. Diagnostic test reports such as
and Development Authority of India Act, 1999; a.any partial or total repudiation of
USG, Pathology / Lab reports etc., • Duly filled in Treating Doctor Certificate • Duly
claims by the life insurer, General insurer or the health insurer; a.disputes over
filled in Medical/ Hospital Attendant Certificate • Duly filled in employer certificate
Premium paid or payable in terms of insurance policy; a.misrepresentation of policy
(only if Life Assured was a salaried individual) For processing Terminal Illness claim
terms and conditions at any time in the Policy Document or policy contract; a.legal
as per this policy, We will require the following documents (as may be relevant): •
construction of insurance policies in so far as the dispute relates to claim; a.policy
Duly filled and signed health claim form • Payout mandate form with bank account
servicing related grievances against insurers and their agents and
details of the claimant • Copy of cancelled cheque / bank statement / bank passbook
intermediaries; a.issuance of life insurance policy, general insurance policy including
of the claimant • Medical documents confirming diagnosis i. A precise diagnosis of
health insurance policy which is not in conformity with the Proposal Form submitted
the treatment for which a claim is made ii. All hospitalization records of the Life
by the proposer; a.non-issuance of insurance policy after receipt of Premium in life
Assured such as: Admission form, Indoor Case Papers (ICPs), Discharge summary,
insurance and general insurance including health insurance; and i.any other matter
Diagnostic test reports confirming diagnosis • Claimant's statement / claim
arising from non-observance of or non-adherence to the provisions of any
intimation form • Medical practioner certificate stating the illness specializing in
regulations made by the Authority with regard to protection of policyholders‘
treatment of illness, is highly likely to lead to death within 6 months from 2 specialist
interests or otherwise, or of any circular, guideline or instruction issued by the
doctors. Claimant address proof • Claimant photo identity proof/Recent photograph
Authority, or of the terms and conditions of the policy contract, in so far as such
of the claimant • Pan card / Form 60 of the claimant Claim payments are made only
matter relates to issues referred to in clauses (a) to (h).
in Indian currency in accordance with the prevailing Exchange control regulations
and other relevant laws and regulations in India. In case the Claimant is unable to Manner in which complaint to be made
provide any or all of the above documents, in exceptional circumstances such as a 1.Any person who has a grievance against an insurer or insurance broker, may
natural calamity, the Company may at its own discretion conduct an investigation himself or through his legal heirs, Nominee or Assignee, make a complaint in writing
and may subsequently settle the claim. to the Insurance Ombudsman within whose territorial jurisdiction the branch or office
11. Suicide If the Life Assured, whether sane or insane, commits suicide within 12 of the insurer or the insurance broker, as the case may be complained against or the
months from the date of commencement of risk of this Policy, We will refund higher residential address or place of residence of the complainant is located. 2.The
of 80% of the total premiums paid, if any till the date of death or unexpired risk complaint shall be in writing, duly signed or made by way of electronic mail or online
premium value as available on the date of death, provided the policy is in force. In the through the website of the Council for Insurance Ombudsmen by the complainant or
case of a revived Policy, if the Life Assured, whether sane or insane, commits suicide through his legal heirs, Nominee or Assignee and shall state clearly the name and
within 12 months of the date of revival of the Policy, higher of 80% of the total address of the complainant, the name of the branch or office of the insurer against
premiums paid, if any till date of death or unexpired risk premium value as available whom the complaint is made, the facts giving rise to the complaint, supported by
on date of death will be payable by Us. The Policy will terminate on making such a documents, the nature and extent of the loss caused to the complainant and the
payment and all rights, benefits and interests under the Policy will stand relief sought from the Insurance Ombudsman. 3.No complaint to the Insurance
extinguished. Ombudsman shall lie unless— a)the complainant has made a representation in
12. Issue of duplicate policy We shall issue a duplicate of Policy document, on writing or through electronic mail or online through website of the insurer or
receipt of a written request for the same from You along with the necessary insurance broker concerned or the insurer named in the complaint and— i.either the
documents as may be required by Us and at such charges as may be applicable from insurer or insurance broker, as the case may be had rejected the complaint; or ii.the
time to time. The current charges for issuance of duplicate policy is ₹ . 200. Freelook complainant had not received any reply within a period of one month after the
option is not available on issue of duplicate Policy document. insurer or insurance broker, as the case may be received his representation; or iii.the
13. Amendment to policy document Any variations, modifications or amendment of complainant is not satisfied with the reply given to him by the insurer or insurance
any terms of the Policy document shall be communicated to you in writing. broker, as the case may be; b)The complaint is made within one year— i.after the
PART-G order of the insurer rejecting the representation is received; or ii.after receipt of
decision of the insurer or insurance broker, as the case may be which is not to the
Policy Servicing and Grievance Handling Mechanism satisfaction of the complainant; iii.after expiry of a period of one month from the date
1.Customer service
Vishal a patil 4056
of sending the written representation to the insurer or insurance broker, as the case
may be if the insurer or insurance broker, as the case may be named fails to furnish 16. PATNA: Office of the Insurance Ombudsman, 2 nd Floor, Lalit Bhawan, North
reply to the complainant. 4.The Ombudsman shall be empowered to condone the Wing Bailey Road, Patna 800001. Tel.: 0612-2547068 Email:
delay in such cases as he may consider necessary, after calling for objections of the [email protected] Areas of Jurisdiction: Bihar,Jharkhand
insurer or insurance broker, as the case may be against the proposed condonation 17. PUNE: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor,
and after recording reasons for condoning the delay and in case the delay is C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030. Tel.:
condoned, the date of condonation of delay shall be deemed to be the date of filing 020-24471175 Email: [email protected] Areas of Jurisdiction:
of the complaint, for further proceedings under these rules. 5.No complaint before the Maharashtra, Area of Navi Mumbai and Thane excluding Mumbai Metropolitan
Insurance Ombudsman shall be maintainable on the same subject matter on which Region.
proceedings are pending before or disposed of by any court or consumer forum or
Annexure I – Section 39 – Nomination by policyholder
arbitrator. 6.The Council for Insurance Ombudsmen shall develop a complaints
management system, which shall include an online platform developed for the Nomination of a life insurance Policy is as below in accordance with Section 39 of the
purpose of online submission and tracking of the status of complaints made under Insurance Act, 1938, as amended from time to time. The extant provisions in this
rule 14 The Ombudsman shall not award compensation exceeding more than regard are as follows: 1. The policyholder of a life insurance on his own life may
Rupees Fifty Lakhs (including relevant expenses, if any). We have given below the nominate a person or persons to whom money secured by the policy shall be paid in
details of the existing offices of the Insurance Ombudsman. We request You to the event of his death. 2. Where the nominee is a minor, the policyholder may
regularly check our website at www.iciciprulife.com or the website of the IRDAI appoint any person to receive the money secured by the policy in the event of
at www.irdai.gov.in for updated contact details. policyholder’s death during the minority of the nominee. The manner of appointment
to be laid down by the insurer. 3. Nomination can be made at any time before the
1. AHMEDABAD: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th maturity of the policy. 4. Nomination may be incorporated in the text of the policy
floor, Tilak Marg, Relief Road, Ahmedabad -380 001 Tel: 079 - 25501201/02/05/06 itself or may be endorsed on the policy communicated to the insurer and can be
Email: [email protected] Areas of Jurisdiction: Gujarat , Dadra & registered by the insurer in the records relating to the policy. 5. Nomination can be
Nagar Haveli, Daman and Diu cancelled or changed at any time before policy matures, by an endorsement or a
2. BENGALURU: Office of Insurance Ombudsman, Jeevan Soudha Building, PID No. further endorsement or a will as the case may be. 6. A notice in writing of Change or
57-27-N-19, Ground Floor, 19/19, 24th Main Road, JP Nagar, 1st Phase, Bengaluru – Cancellation of nomination must be delivered to the insurer for the insurer to be liable
560078 Tel: 080 - 26652048 / 26652049 Email: [email protected] to such nominee. Otherwise, insurer will not be liable if a bonafide payment is made
Areas of Jurisdiction: Karnataka to the person named in the text of the policy or in the registered records of the
3. BHOPAL: Office of the Insurance Ombudsman, 1 st floor, “Jeevan Shikha”, 60-B, insurer. 7. Fee to be paid to the insurer for registering change or cancellation of a
Hoshangabad Road, Opp. Gayatri Mandir, Bhopal – 462011. Tel: 0755-2769201, nomination can be specified by the Authority through Regulations. 8. On receipt of
2769202 and 2769203 Email: [email protected] Areas of Jurisdiction: notice with fee, the insurer should grant a written acknowledgement to the
Madhya Pradesh & Chhattisgarh policyholder of having registered a nomination or cancellation or change thereof. 9. A
transfer or assignment made in accordance with Section 38 shall automatically
4. BHUBANESHWAR: Office of the Insurance Ombudsman, 62, Forest park,
cancel the nomination except in case of assignment to the insurer or other transferee
Bhubneshwar – 751 009. Tel: 0674-2596455/2596249/2596003 Email:
or assignee for purpose of loan or against security or its reassignment after
[email protected] Areas of Jurisdiction: Odisha
repayment. In such case, the nomination will not get cancelled to the extent of
5. CHANDIGARH: Office of the Insurance Ombudsman, Jeevan Deep Building, SCO insurer’s or transferee’s or assignee’s interest in the policy. The nomination will get
20-27, Ground Floor, Sector-17-A, Chandigarh - 160017 Tel.: 0172 -2706468 Email: revived on repayment of the loan. 10. The right of any creditor to be paid out of the
[email protected] Areas of Jurisdiction: Punjab, proceeds of any policy of life insurance shall not be affected by the nomination. 11. In
Haryana(excluding Gurugram, Faridabad, Sonepat and Bahadurgarh) Himachal case of nomination by policyholder whose life is insured, if the nominees die before
Pradesh, Union Territories of Jammu & Kashmir, Ladakh & Chandigarh. the policyholder, the proceeds are payable to policyholder or his heirs or legal
6. CHENNAI: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, representatives or holder of succession certificate. 12. In case nominee(s) survive the
453, Anna Salai, Teynampet, Chennai – 600 018. Tel.: 044 - 24333668 / 24333678 person whose life is insured, the amount secured by the policy shall be paid to such
Email: [email protected] Areas of Jurisdiction: Tamil Nadu, Tamil survivor(s). 13. Where the policyholder whose life is insured nominates his a. parents
Nadu Puducherry Town and Karaikal (which are part of Puducherry). or b. spouse or c. children or d. spouse and children e. or any of them the nominees
7. DELHI: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, are beneficially entitled to the amount payable by the insurer to the policyholder
Asaf Ali Road, New Delhi – 110 002. Tel 011 – 46013992/23213504/23232481 unless it is proved that policyholder could not have conferred such beneficial title on
Email: [email protected] Areas of Jurisdiction: Delhi & Following Districts the nominee having regard to the nature of his title. 14. If nominee(s) die after the
of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. policyholder but before his share of the amount secured under the policy is paid, the
share of the expired nominee(s) shall be payable to the heirs or legal representative
8. KOCHI: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC
of the nominee or holder of succession certificate of such nominee(s). 15. If
Building, Opp to Maharaja's College,M.G.Road, Kochi - 682 011. Tel.: 0484 –
policyholder dies after maturity but the proceeds and benefit of the policy has not
2358759 Email: [email protected] Areas of Jurisdiction: Kerala,
been paid to him because of his death, his nominee(s) shall be entitled to the
Lakshadweep, Mahe-a part of Union Territory of Puducherry.
proceeds and benefit of the policy. 16. The provisions of Section 39 are not applicable
9. GUWAHATI: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Nr. to any life insurance policy to which Section 6 of Married Women’s Property Act,
Panbazar over bridge, S.S. Road, Guwahati – 781001 (Assam). Tel.: 0361 - 1874 applies or has at any time applied. Where nomination is intended to be made
2632204 / 2602205 / 2631307 Email: [email protected] Areas of to spouse or children or spouse and children under Section 6 of MWP Act, it should
Jurisdiction: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland be specifically mentioned on the policy. In such a case only, the provisions of Section
and Tripura. 39 will not apply. Disclaimer: This is a simplified version of Section 39 of the
10. HYDERABAD: Office of the Insurance Ombudsman, 6-2-46, 1st floor, "Moin Insurance Act, 1938, as amended from time to time. The policyholders are advised to
Court", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad refer to The Insurance Act, 1938, as amended from time to time for complete and
- 500 004. Tel.: 040 -23312122 // 23376991 / 23376599 / 23328709 / 23325325 accurate details.
Email: [email protected] Areas of Jurisdiction: Andhra Pradesh, Annexure II – Section 38 – Assignment and Transfer of Insurance Policies
Telangana, Yanam and part of Union Territory of Puducherry. Assignment or transfer of a policy should be in accordance with Section 38 of the
11. JAIPUR: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Insurance Act, 1938, as amended from time to time. The extant provisions in this
Floor,Bhawani Singh Marg,Jaipur - 302 005. Tel.: 0141- 2740363 Email: regard are as follows: 1. This policy may be transferred/assigned, wholly or in part,
[email protected] Areas of Jurisdiction: Rajasthan with or without consideration. 2. An Assignment may be effected in a policy by an
12. KOLKATA: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th endorsement upon the policy itself or by a separate instrument under notice to the
Floor,4, C.R. Avenue, Kolkatta - 700 072 Tel.: 033 - 22124339 / 22124341 Email: Insurer. 3. The instrument of assignment should indicate the fact of transfer or
[email protected] Areas of Jurisdiction: West Bengal, Sikkim, assignment and the reasons for the assignment or transfer, antecedents of the
Andaman & Nicobar Islands. assignee and terms on which assignment is made. 4. The assignment must be
signed by the transferor or assignor or duly authorized agent and attested by at least
13. LUCKNOW: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan,
one witness. 5. The transfer of assignment shall not be operative as against an
Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001. Tel.: 0522 -
insurer until a notice in writing of the transfer or assignment and either the said
4002082 / 3500613 Email: [email protected] Areas of Jurisdiction:
endorsement or instrument itself or copy there of certified to be correct by both
Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot,
transferor and transferee or their duly authorised agents have been delivered to the
Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur,
insurer. 6. Fee to be paid for assignment or transfer can be specified by the Authority
Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki,
through Regulations. 7. On receipt of notice with fee, the insurer should Grant a
Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti,
written acknowledgement of receipt of notice. Such notice shall be conclusive
Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar,
evidence against the insurer of duly receiving the notice. 8. If the insurer maintains
Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.
one or more places of business, such notices shall be delivered only at the place
14. MUMBAI: Office of the Insurance Ombudsman,3rd Floor, Jeevan Seva Annexe, S. where the policy is being serviced. 9. The insurer may accept or decline to act upon
V. Road, Santacruz (W), Mumbai - 400 054. Tel.: 022 - 69038800/27/29/31/32/33 any transfer or assignment or endorsement, if it has sufficient reasons to believe that
Email: [email protected] Areas of Jurisdiction: Goa, Mumbai it is a. not bonafide or b. not in the interest of the policyholder or c. not in public
Metropolitan Region excluding Navi Mumbai & Thane. interest or d. is for the purpose of trading of the insurance policy. 10. Before refusing
15. NOIDA: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4 th Floor, to act upon endorsement, the Insurer should record the reasons in writing and
Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301. Tel.: communicate the same in writing to Policyholder within 30 days from the date of
0120-2514252 / 2514253 Email: [email protected] Areas of policyholder giving a notice of transfer or assignment. 11. In case of refusal to act
Jurisdiction: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, upon the endorsement by the Insurer, any person aggrieved by the refusal may
Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, prefer a claim to IRDAI within 30 days of receipt of the refusal letter from the Insurer.
Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, 12. The priority of claims of persons interested in an insurance policy would depend
Farrukhabad, Firozbad, Gautam buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, on the date on which the notices of assignment or transfer is delivered to the insurer;
Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, where there are more than one instruments of transfer or assignment, the priority
Saharanpur. Vishal a patil 4056
will depend on dates of delivery of such notices. Any dispute in this regard as to
priority should be referred to Authority. 13. Every assignment or transfer shall be ground and materials on which such decision is based. 3. Fraud means any of the
deemed to be absolute assignment or transfer and the assignee or transferee shall following acts committed by insured or by his agent, with the intent to deceive the
be deemed to be absolute assignee or transferee, except a. where assignment or insurer or to induce the insurer to issue a life insurance policy: a) The suggestion, as a
transfer is subject to terms and conditions of transfer or assignment OR b. where the fact of that which is not true and which the insured does not believe to be true; b)
transfer or assignment is made upon condition that i. the proceeds under the policy The active concealment of a fact by the insured having knowledge or belief of the
shall become payable to policyholder or nominee(s) in the event of assignee or fact; c) Any other act fitted to deceive; and d) Any such act or omission as the law
transferee dying before the insured OR ii. the insured surviving the term of the specifically declares to be fraudulent. 4. Mere silence is not fraud unless, depending
policy Such conditional assignee will not be entitled to obtain a loan on policy or on circumstances of the case, it is the duty of the insured or his agent keeping silence
surrender the policy. This provision will prevail notwithstanding any law or custom to speak or silence is in itself equivalent to speak. 5. No Insurer shall repudiate a life
having force of law which is contrary to the above position. 14. In other cases, the insurance Policy on the ground of Fraud, if the Insured / beneficiary can prove that
insurer shall, subject to terms and conditions of assignment, recognize the transferee the misstatement was true to the best of his knowledge and there was no deliberate
or assignee named in the notice as the absolute transferee or assignee and such intention to suppress the fact or that such mis-statement of or suppression of
person a. shall be subject to all liabilities and equities to which the transferor or material fact are within the knowledge of the insurer. Onus of disproving is upon the
assignor was subject to at the date of transfer or assignment and b. may institute policyholder, if alive, or beneficiaries. 6. Life insurance Policy can be called in question
any proceedings in relation to the policy c. obtain loan under the policy or d. the within 3 years on the ground that any statement of or suppression of a fact material
policy without obtaining the consent of the transferor or assignor or making him a to expectancy of life of the insured was incorrectly made in the proposal or other
party to the proceedings Disclaimer: This is a simplified version of Section 38 of the document basis which policy was issued or revived or rider issued. For this, the
Insurance Act, 1938, as amended from time to time. The policyholders are advised to insurer should communicate in writing to the insured or legal representative or
refer to The Insurance Act, 1938, as amended from time to time for complete and nominee or assignees of insured, as applicable, mentioning the ground and materials
accurate details. on which decision to repudiate the policy of life insurance is based. 7. In case
Annexure III – Section 45 – Policy shall not be called in question on the ground of repudiation is on ground of mis-statement and not on fraud, the premium collected
mis-statement after three years on policy till the date of repudiation shall be paid to the insured or legal
Provisions regarding policy not being called into question in terms of Section 45 of representative or nominee or assignees of insured, within a period of 90 days from
the Insurance Act, 1938, as amended from time to time are as follows: 1. No Policy of the date of repudiation. 8. Fact shall not be considered material unless it has a direct
Life Insurance shall be called in question on any ground whatsoever after expiry of 3 bearing on the risk undertaken by the insurer. The onus is on insurer to show that if
yrs from a) the date of issuance of policy or b) the date of commencement of risk or c) the insurer had been aware of the said fact, no life insurance policy would have been
the date of revival of policy or d) the date of rider to the policy whichever is later. 2. issued to the insured. 9. The insurer can call for proof of age at any time if he is
On the ground of fraud, a policy of Life Insurance may be called in question within 3 entitled to do so and no policy shall be deemed to be called in question merely
years from a) the date of issuance of policy or b) the date of commencement of risk because the terms of the policy are adjusted on subsequent proof of age of life
or c) the date of revival of policy or d) the date of rider to the policy whichever is insured. So, this Section will not be applicable for questioning age or adjustment
later. For this, the insurer should communicate in writing to the insured or legal based on proof of age submitted subsequently.
representative or nominee or assignees of insured, as applicable, mentioning the

Vishal a patil 4056