Dark Secrets, Claim Disputes & Hidden Clauses in TERM INSURANCE | Shrehith Karkera
Vložit
- čas přidán 28. 06. 2024
- ► Need Term or Health Insurance?
Schedule a free 30-minute consultation : ditto.sh/0bxlo5
► 26,000+ readers have joined my Investing Newsletter
Subscribe Now : shankarnath.com
I recently did a podcast with Shrehith Karkera, the Co-Founder of Ditto Insurance and Finshots where he answered 20 of the toughest & most challenging questions on term insurance that you (my channel viewers) had posted in an earlier community post. For someone who's had a term insurance policy for over 14 years, I found this podcast session very informative and I'm sure you'll pick some good suggestions & advice from it
👉 Video Chapters:
00:00 Introduction
02:00 IIM Ahmedabad to Finshots to Ditto
06:42 Building Ditto with Inbound Leads rather than Telecalling
15:00 Till What Age Should I Take Term Insurance?
18:52 How Much Term Insurance Coverage Do I Need?
22:22 Importance of Claim Settlement Ratio
28:03 Complaints against Life Insurers
30:27 Critical Illness Rider in Term Insurance Plans
33:26 Choosing the Cheapest Term Insurance Policy
36:21 Case study 1 -- Suicide
43:05 Case study 2 -- Critical illness
46:24 Filing a Complaint with the Ombudsperson
48:13 What happens if a Smoker later turns into a Non-smoker & vice-versa
50:19 Term Insurance Options for Smokers
55:28 Can Someone with a Pre-Existing Condition Get a Term Insurance Policy?
58:42 Case study 3 -- Rejected application
1:00:27 Can a ULIP or Traditional Plan be a Worthy Substitute for Term Insurance?
1:02:06 Do I Need to Report Changes in My Lifestyle/Medical Condition to the Insurer?
1:04:30 Case study 4 -- Acknowledgement from Insurer
1:07:11 Should I Split/Diversify my Term Insurance Coverage amongst Multiple Insurers?
1:09:12 What are Zero Cost Term Insurance Plans?
1:12:41 Who Receives the Death Benefit if the Insured & Nominee have Expired?
1:13:47 How Can I Increase the Sum Assured of my Term Insurance Plan?
1:17:07 Term Insurance plans for NRIs (Non Resident Indians)
1:21:18 Insurance Claim Process in Missing Person(s) cases
1:23:20 Are Defence Personnel (Soldier, Police etc.) Eligible for a Term Insurance Plan
1:25:00 Term Insurance Premiums are Rising over 3-4 Years. Why?
1:29:15 Shankar's Takeaways
#terminsurance #lifeinsurance #dittoinsurance
Disclaimer: I am not a SEBI registered investment advisor or research analyst. I am not registered with PFRDA or IRDA either. The content posted on this platform is purely for educational purposes and none of it constitutes investing or trading advice. Viewers should do their own research and diligence before investing or acting on the information presented. Some of the links I have posted in the video, the description, the comments and other related resources might be affiliate links
👉 Book a FREE call with Ditto: bit.ly/3UO1YFa
This podcast has been an enlightenment for me personally, would appreciate it if you can attempt similar podcasts on mediclaim schemes, which is personally a black box for me.
Thank you 👍
This is the most comprehensive video about life insurance that I have seen with very good quality questions.
Please do a similar video for health insurance.
Thank you! Glad you liked it. Sure, I'll try to setup a similar video on health insurance
One of the excellent podcasts I have ever seen on term insurance. Thanks Shankar for arranging this important session.
Most welcome 🙌 I'm happy you found it useful, lots to learn
I had a consultation with Ditto for 20 mins but this video has got good amount of information where it makes you think new aspects and answers all. One thing fears me lot, the processing of letting the insurer or agent know of health condition in between, what if insurer rejects your policy after 4 yrs, I think insurance TNC has to mature a lot where there can be multiple checks and stringent validations before issuing the policy post that they have to support the holder, because all these claims are done on someone’s demise and done by who are at huge loss, without this kind of support people wouldn’t get convinced to get policies
I like to draw a decision tree when in doubt.
So scenario 1 is I inform the insurer of a change in my health condition while I am alive --
1.a) Insurer acknowledges in the lines of "claim will not be affected" which is a big assurance. Or maybe doesn't acknowledge but still, I have sent the information on a timely basis
1.b) Insurer rejects or creates impediment (like saying I had pre-existing condition) which gives me an opportunity to represent myself to the ombudsperson or IRDAI or to a court
Scenario 2 is I keep mum about my health condition. I die over time and in in that case --
2.a) Insurer is a nice guy and processes claim ignoring my health condition plus following the 5-year moratorium clause as defined by the IRDAI
2.b) Insurer rejects claims and my beneficiary is hassled trying to disprove the insurer's contention
There are no right or wrong answers here, just probabilities (like most things in life)
I am sure this will be most valuable video, insurance companies are the biggest cheaters in modern India ... I have personal bad experience with them but i didn't leave them scot-free, took to Ombudsman and then to court for getting a verdict favourable.. But you have to be determined enough to fight them out ...
Can you please tell us the process to go to consumer court after Ombudsman like register the complaint through online or offline, website link etc... as much as possible...
Hmm .. if one puts oneself in the insurer's place; i.e. offer a 98% delivery of services and if you're called a cheat -- it won't be fair! At a claim settlement ratio of 98%+ (by count of policies) and 90%+ (by amount), term insurers do their bit to ensure the promised amount goes to the beneficiary. The gap/dispute (10%) are often edge cases -- some of them mild (like documentation), some of them hard (pre-existing illness) and rest of them outright concrete (fraud*). Sometimes the insurer is at fault and sometimes the policyholder.
As consumers, we have a few recourses and this podcast's real message is to understand these and plan better. Recapping it here --
1. Have a better understanding of the term insurance policy you are enrolling into (incl. critical illness, suicide clause)
2. Be 100% honest in your application about your condition & disclosures
3. Buy via a broker/agent as it offers a second layer of dispute protection
4. There is a complaint structure in place with ombudsperson & courts. And Shrehith's suggestion is to definitely use it if & when the need arises
* I want to recite an incident that I experienced in my Insurance days on how consumers skim insurance companies. So in Gujarat (I think or maybe Madhya Pradesh), a scheme was launched where every bag of Urea the farmer purchases has an in-built life cover of 50,000 rupees. Let's say a farmer buys 10 bags of Urea in a season and if he/she were to die, the beneficiary can get those Urea bags to the nearby insurance offices and claim the life insurance cover. So the insurance model was created assuming an average of 5,00,000 rupees of life insurance cover. The first year was fine (not too many claims), so was the 2nd year, but here's what happened in year 3.
In the 3rd year, someone figured that the system can be gamed. So when a farmer next died in that village, all the villagers would get together with whatever number of Urea bags they had with them and would give it all to the beneficiary. This would often come to 300 - 400 bags of Urea. The beneficiary would then approach the insurer and claim 1.5 to 2 crores. This caught on and the insurer started receiving claims of 300, 400, even 800 bags on one occasion making the entire exercise unviable for the insurer. Ergo, the insurer took the losses, closed down the program and the farmers lost their life insurance protection because some of them tried to cheat their way in
My point is -- disputes happen both ways. Some initiated by the insurer, some initiated by the consumer. As consumers, we should hold our end of the deal (point 1 & 2 above) and use the help of authorities (point 3 & 4 above) as and when needed for a resolution.
Sorry! I've seen all sides of it, having been a 1. consumer (multiple term & health insurance policies), 2. distributor (ICICI Bank, GE Consumer Finance & ET Money) and 3. insurer (Chubb, Bharti AXA & HDFC Life) -- hence the longish message
Thank you for the appreciation, I'm glad you liked this podcast! 🙌
@@shankarnath Thanks for great session and detailed explanation with example . This helps .
@@shankarnathSir, what is the cheapest and honest life insurance policy for a middleclass family according to you ? I don't want accidental insurance as it is covered by my employer (state PSU) and my wife's employer ( state government) ?
@@Traderking1990 You'll have to check with the folks at Ditto, they know this stuff better than me .. link: bit.ly/3UO1YFa
This is so detailed and wonderful podcast . So much informative.. thanks Shankar and shrehith ..
Glad you liked it. Thank you very much for listening 🙌
Great video! This is going straight into my playlist on personal finance.. and I am going to perhaps watch it many many times
Glad you liked it. Yes, lots of useful information here on a product that many of us buy -- term insurance. Please share it with your friends & family too, they might find it useful aswell
Very insightful and detailed, Please keep going 🙏
Thank you! Yes, there are a lot of finer details that Shrehith has explained here, glad you found them useful
Mr.Shankar..its a worth..worth..and worth.....thanks for your work
My pleasure! Glad you liked this, Shrehith has put forth many insightful and thoughtful points
if we split insurance with different providers then chances of claim approval much as values are small to approve
Excellent information. Thanks alot shankar
Most welcome. Glad you found it useful
Very valuable information about need of insurance for an individual.
Glad you found it useful!
Excellent discussion. Thanks a lot.
Glad you liked it! 🙌
Enjoyed the conversation, very good useful session
Great to hear! Podcasts are long (one has to be patient to go through it) but then Shrehith gave many suggestions & statements related to a product we all buy (term insurance) that makes this one worth it. Thx for listening through it
Excellent podcast, Mr. Shankar. Request you to do a dedicated one on Health Insurance.
Thank you very much! 🙌
Really enjoyed this podcast thank you Shankar
Thank you very much!
Amazing podcast.. I loved it. The kind of queries you have discussed Sankar makes sense and real scenarios.
Thank you very much 🙌
@@shankarnath Also, I love your analysis videos on sectors. Liked the way you analysed Cement, Sugar and other sectors. Very deeply analysed. Thanks a lot.
@@kunubal1 Thank you! Which sector analysis is your favourite? Mine is hospitals and hotels
@@shankarnath Lovely! Mine is cement sector. Learnt a lot how Shree cement is able to reduce their expense in this competitive environment where almost in every parts of India they have to manufacture cement. Thanks a lot.
Is Ditto a non-profit company. Would like to understand how you people (Ditto) earn to survive and pay your affiliates, please.😊
Ditto is a for-profit company. They are distributors of insurance and are paid a commission by the insurance companies for enrolling people like you & me into term insurance and health insurance plans. Payouts differ from insurer to insurer and product to product but as a thumbrule, the gross payout for term insurance is somewhere around 40% of first year's premium and 15-20% of health insurance premium (1st year and renewal). This commission pays for the distributors infrastructure, employees, marketing expenses, admin, compliance costs etc.
As Shrehith explained in the podcast, Ditto procures leads using inbound enquiries i.e. prospects have to book a call with Ditto advisors. Plus by offering above-par service, Ditto gets a lot of referrals also which is free marketing/leads. This is Ditto's operating model. In sharp contrast is Policybazaar which uses outbound telemarketing to pitch to prospects. At ET Money, the insurance process I had created was based around cross-selling to existing MF client with partial use of telecalling advisors. So every company follows a slightly different operating model which has a bearing on costs and profits.
I don't have specifics on exact revenue, costs, profits or margins but I hope the above helps you paint a picture
Hi
Excellent podcast
Was a true eyeopener
Thanks for listening. Some of them were quite surprising like the insurer continuing it's investigation even after the term insurance policy is issued. Glad you found it useful
Very nice video !!!… Thanks S&S..!, I remember case of my brother in which I took pre approval from SBI medical insurance for removal of lipoma with all pre tests etc done . Even though getting nod from sbi, and even though I have submitted all the documents via e mail in sbi Mumbai office after the surgery , till date after 7 yrs I haven’t got the reimbursement . So my small suggestion is that choose the company whose HQ is in the city so that you can personally go to their office and argue your case. Also never have auto debt feature for renewal of insurance . After this incident I changed the company and it took me months to clear this facility from sbi as sbi were bent upon not to let go the customer .
Most welcome, glad you liked it 🙌 I hope you took up the case with the Ombusperson or consumer court, things move faster when the consumer involves the authorities
Hi Shankar
Thank you so much for your contents. Not only for this podcast but also for all the quality content which is rare in this sea of youtube. This is a small encouragement for the good service you are doing. Please keep it up. As you said you are targeting the audiences who are already graduated from the beginners level and looking for the content of next level. You are doing the right thing appealing for such viewers. ❤
Srehith is an encyclopedia in his subject. Got a lot of insights from this conversation. Though this was a long podcast but still I was glued to it till end of it.
See if possible please create some content on MF. I have watched all your videos on this topic earlier. Following you from ET Money days. I don't know what but something next level in MF investing to boost return over long term.
Thank you very much for your kind appreciation 🙌 Yes, Shrehith definitely knows his stuff and it was a pleasure understanding the nitty-gritties of term insurance from him. I'm glad you liked it.
Great conversation Recently i had pathetic experience for Health insurance claim ...holding policy for 15 Yr, post hospitalization, got reimbursed 65% of amount from Employer insurance, then applied for balance 35% with Personal ( Star Health )....they simply underpaid even if all amount qualifies....since i am aware of Insurance Ombudsman as well as ready to go to consumer court, i will get all Due credits....but in nutshell getting any insurance claim is not easy....Sell of insurance is smooth, getting money back even if you have all disclosure, Documents is TOUGH....sometime feel better to build Medical corpus by SIP than go for insurance
Thanks! I had a hitch too with re: my parent's health insurance but then the hospital co-operated and the doctor spoke to the TPA/insurer a couple of times when they had sent for a clarification. The approval came thanks to this intervention for the 2nd surgery. I remember waiting at the counter with some cash in hand when the person behind the counter said "So Sir, 15000 rupees mujhe apko wapas dene hain". What had happened is that 100% of the claim (every rupee) went through and the hospital ended up returning the 15,000 rupees they had taken initially as a deposit. But yes -- claims is not a standardized process and I don't see how & why it will become one. As consumers, we need to learn on how to turn the tide in our favour. Shrehith gave some excellent pointers with re: term insurance
Such Great Podcast Mr. Shankar. Thank you so much.
Most welcome! 🙌
@@shankarnath Sir pls also do video on Health Insurance.
@@ajayghodake9914 I'll try, thanks!
Excellent job ❤❤
Thank you! 😊
Loved the podcast
Thank you Akhil 🙌
Great video❤ have been following your videos since your ET money journey :)
I appreciate that! Thank you so much 🙌
Great job Shankar, it was enlightenment. Could you please do one for health insurance, i feel that is more murky and complex. For example i have care insurance and once in a while they keep removing a big hospital near my house from cashless list which is sad.
Thank you! I'll try to do one for health insurance too. Insurers add/remove hospitals from time to time due to a number of reasons. The top ones are :
1. Expiry of agreement
2. Disagreement on fees -- the insurer and hospital agree on per treatment charges; conflict often erupt
3. Fraud by the hospital (over-billing, fictitious patients, forging reports etc.)
4. Hospital opting out due to delays in payment of cashless treatment charges (I think normal cycle is 30 days which means with cashless increasing the hospital has to have atleast 30 days of working capital which can run into a few crores)
5. Customer complaints
Maza aa gaya full podcast dekha bahut time baad 👍
More power to you 🫰
Thank you! Glad you liked it, lots of good stuff by Shrehith
Can please share all questions and answers as its excellent interview
You can use websites like youtubetranscript.com to help you with it
So i have to tell my insurer about the new medication i have been prescribed. I hope policy Bazzar folks can help me with this shit.
Btw, great Video Shankar Sir, you got my question answered, more power to you for making this. 🙌
Thank you! Glad you found it useful!
Is it good to buy term plan with a limited ppt Or the health insurance with 2 or 3 yrs premium paid at once. Or is it advisable to go for a regular annual premium payment option.
Others might have a different viewpoint but I prefer the annual premium payment option as it gives me an option to lapse the term insurance contract if & when I don't have the need for term insurance anymore. Health insurance, it's OK to pay 3 years of premium in one shot
Health insurance policy awareness and real time issue with it
How to change advisor in regular fund?if there is no redemption,only adviser change,hope there is no capital gain tax issue envolve???
Pls confirm, thanks
Pls try this route: www.camsonline.com/Distributors/Service-Requests/Service-Request-Forms/Change-Broker
Relating to the point of Life insurance claim rejection basis involvement in criminal activities. Suppose one happen to get involved in a brawl or civil unrest and dies due to injuries, what happens to the claim?
The policy wordings of every life insurance policy has a comprehensive list of exclusions in it. Please read that for a better understanding of situations that void the claim.
Hi Mr Shankar, Can you please make a video on mutual fund investing for beginners and also talk about commissions and other expenses involved in this?
Thanks
Thanks for the suggestion, Mr. Mathews. I'll try
@@shankarnath Thank you!
Sorry to hear that defence and police in duty are not covered?
Hi Shankar
Just came across one topic in MF gain tax free for NRIs in UAE. Yesterday I saw it in GROWW youtube channel that NRIs from UAE need not pay any tax on capital gain. This is as per the DTAA between 2 countries. It was also mentioned that many don't know about this and not even some of the tax officials. I am not sure about this claim. Thousands of NRI investors are investing in Indian MFs and are paying tax. How come this is not known to anyone? ..
Hello Dr. Avinash, there have been previous articles in this context. Here's one by Mint: www.livemint.com/money/personal-finance/why-nris-in-uae-enjoy-tax-benefits-on-mf-investments-11707841196793.html
❤❤❤❤
Hi Shankar, I got my term insurance 10 years ago. I have now moved overseas since last 2 years. Is there a risk to my policy here? Do i need to declare anything here? Thanks
Hi. My understanding -- the term insurance contract is still valid and continues to cover you if premiums are being paid on time. There is no harm in declaring it to the life insurance company. For a solid second opinion, pls connect with the folks at Ditto over call or whatsapp .. link: bit.ly/3UO1YFa
Moratorium is applicable for port as well hence even if you port it's not like it will start from 0
My understanding is that one loses the moratorium if you port to a different insurer. I recently thought of porting my policy but the Ditto guys told me this and on their advice, I kept it with the same health insurer but then upgraded to a superior plan but got an email confirmation from them that the moratorium continues even in the upgraded plan.
@@shankarnath great, however you can check with insurance regulator IRDAI as well if you increase your sum insure then additional difference will not come under moratorium however you previous base sum insurance will have no impact, existing insurer might continue moratorium for updated premium as well, I recently ported my parents insurance and moratorium along with waiting period continues,
@@anmolkissen5199 Thanks for the suggestion. Since I've received the confirmation on email from my original insurer inspite of moving to a new product, I'm pretty much sorted.
@@shankarnath yup and by the way great pod caste nice work
❤
Now it is 5 year moratorium
Is this moratorium period for health insurance or term insurance?
Actually, the term insurance moratorium (in context of this podcast) is still 3 years. It's the health insurance moratorium period that has reduced from 8 years to 5 years recently. Infact, when I enquired about my health insurance renewal from the Ditto team - it was still 8 years.
Sir
How to contact u?
You can write to me at hello@beginnersbuck.com
Hey Shankar,
What if the Ditto guys shut down after some years or behave differently than now. Can we trust them as equally as local agents? What's wise to choose?
Hello, anyone can shutdown. Even with agent, I think lakhs of agents move into and out of this insurance middleman profession. That way established companies (and there are very few -- Ditto & Policybazaar being the prominent ones) are less likely to shut shop and move cities. The same applies to behaviour aswell.
I look at the entire situation as a 1st, 2nd and 3rd recourse. So first step is to take deal with the insurer, if that doesn't work then the middleman comes in (Ditto or others) and finally there is the IRDAI/courts who will listen to our problems (if any). The point is -- one should give oneself the best opportunity of making a case incase a dispute arises
Ofcourse I really can't guess 20 years in the future if a company or an agent will be there or what their behaviour will be -- and neither can you. So its a game of probability, one should do what their rational mind says and where their comfort is.
The content is good but the way it has been presented to viewers could have been better
What would you have done differently?
Less talk and more data on board
The reason for the disputes are primarily the business model of the insurance companies. What is the logic of such high commissions being paid to the agents.
1. Curious to know - how would an improved insurance business model look like?
2. Sorry, I haven't come across any formal justification from the IRDAI on commissions (IRDAI decides on the commission upper cap). Perhaps you can file an RTI on this, will be interesting to understand the response.
@@shankarnath . I know it is a simplistic approach but if these companies reduce the absurd targets set for their Salesforce and train them better the consumers would be benefited immensely. Most of the sales staff know that they have to sell the insurance product without knowing the details of the same. End result rampant misselling, wrong products being sold to wrong people and aggrieved consumers during the time of claims. Applies both for life and health products. The huge commissions also lure the agents to missell. A better payout structure and better training and more importantly a little more honesty from the insurance companies will be of great help for all.
17:24 Financial Replica of yourself = Term Insurance
46:20 Have Agent.
Nice interview. Two mistakes. There’s zero need (or use) to inform life insurance company about any health developments after buying policy if premiums are paid on time. Second, you need to inform the company if you are going abroad after buying policy as an Indian resident, as residents of some nations are considered not insurable at all (by at least some Indian life insurers).
Thanks! Curious on your first point -- wouldn't informing the life insurance company (and if they acknowledge it) not make the case during claims even more solid rather than keeping quiet about it? I ask so because Shrehith & Ditto have understandably gone through dozens of such prickly situations & spoken to policyholders/insurance companies at length on dos & don'ts
@@shankarnath There's no need. Any health issue happening after the policy is bought need not be informed to the insurer. It's like the smoking example in the interview. Maybe a psychological relief for the customer. Could backfire if that info leads to some innocuous issues prior to policy date.
Like , you send info about a hernia operation to life insurance company post the policy issue, they find (if a death claim arises) with that hospital number that you had viral fever 2 years ago ..which you did not disclose in proposal. Desperate companies could reject death claim based on that. Sec 45 doesn't cover anything within 3 years prior to date of issue ... even undisclosed viral fever is sufficient to reject a death claim though most companies would not. Coming from someone who has overseen processing of thousands of death claims 😊