Insurance Contract: Features, Term & Conditions of Insurance Contract (How it Works)

In InsuranceSamadhan.com’s A-Z Blog series on Insurance topics, we try to provide all vital information related to the Insurance sector and demystify certain myths related to the sector. In today's blog, we are sharing detailed information regarding – Insurance Contract – and everything that one needs to know.

Insurance Contract is an agreement between Insured and Insurer enforceable by law. Here Insurer promises to pay a sum assured on the occurrence of an event like death. In exchange, insured promises to pay a regular premium.

Insurance Contract Terms and Conditions

A valid legal contract must follow certain conditions which is binding on all parties. These conditions are listed below:

1. Offer and Acceptance

Here to be insured proposes with definite terms and conditions and Insurer can revert with three options:

• Accept the proposal under standard T & C

• Reject the proposal by giving specific answer

• Revise by giving a counter offer.

2. Consideration

To enforce the contract. Proposer must pay a premium which is called consideration. This premium is given in exchange for a promise by Insurer to pay the claim. So a contract is valid only if the Insurer accepts the application form along with the premium and the insurer accepts the proposal and confirms the same in writing.

3. Legal Purpose

A contract is valid only if the purpose of the contract is legal. Insurance purpose is considered legal as insurer is managing the risk and insurer is creating a pool for risk management

4. Competent Parties

A legal contract must be made with a competent person which means a contract cannot be made with minors, mentally infirm and people under use of drugs. Insurers in India must have a license from IRDA.

Features of Insurance Contract

Given below are the few features of Insurance contract, these features are unique:-

1. Aleatory

Insurance contracts are Aleatory as promise comes into picture only on occurrence of event. This occurrence of events is based on probability and occurrence of events is not controlled by any party.

2. Adhesion

Here the contract is prepared by the insurer and the insured accepts given terms and conditions without any negotiation.

3. Unilateral

Here Insurer makes any enforceable promise. Insured does not make any promise but is bound by the terms and conditions of policy where contract can be lapsed if renewal premiums are not paid.

4. Personal Contract

Life insurance is a personal contract or personal agreement between the insurer and the insured. The owner of the policy has no bearing on the risk the insurer has assumed. For this reason, people who buy life insurance policies are called policy owners rather than policyholders. Policy owners actually own their policies and can give them away if they wish. This transfer of ownership is known as assignment. To assign a policy, a policy owner simply notifies the insurer in writing. The company will then accept the validity of the transfer without question. The new owner is granted all of the rights of policy ownership.

5. Conditional

An insurance contract is conditional. This means that the insurer’s promise to pay benefits depends on the occurrence of an event covered by the contract. If the event does not materialize, no benefits are paid. Furthermore, the insurer’s obligations under the contract are conditioned on the performance of certain acts by the insured or the beneficiary. For example, the timely payment of premiums is a condition for keeping the contract in force. If premiums are not paid, the company is relieved of its obligation to pay a death benefit.

6. Valued or Indemnity Contract:

An insurance contract is either a valued contract or an indemnity contract. A valued contract pays a stated sum regardless of the actual loss incurred. Life insurance contracts are valued contracts. If an individual acquires a life insurance policy insuring her life for Rs 500,000, that is the amount payable at death. There is no attempt to value actual financial loss upon a person’s death.

An indemnity contract, however, is one that pays an amount equal to the loss. Contracts of indemnity attempt to return the insured to their original financial position. Fire and health insurance policies are examples of indemnity contracts. An insured that owns a Rs. 500000 fire insurance policy and suffers a Rs. 50,000 loss due to fire will be able to collect up to Rs. 50,000, not Rs. 500,000.

7. Utmost Good Faith:

Insurance is a contract of utmost good faith. This means both the policy owner and the insurer must know all material facts and relevant information. There can be no attempt by either party to conceal, disguise, or deceive. A consumer purchases a policy based largely on the insurer and agent’s explanation of the policy’s features, benefits, and advantages. Insurance applicants are required to make a full, fair and honest disclosure of the risk to the agent and insurer.

8. Material Facts:

All facts which need can affect the occurrence of risk must be declared. It becomes part of the contract and, if found to be untrue, can be grounds for revoking the contract. Facts are presumed to be material because they affect the insurer’s decision to accept or reject an applicant.

In most cases, life insurers have only a limited period of time to uncover false warranties, misrepresentations, or concealment. After that time period passes (normally two years from policy issue), the contract cannot be voided or revoked for these reasons under section 45 of Insurance Act

9. Insurable Interest:

Another element of a valid insurance contract is insurable interest. Insurable interest is a component of legal purpose. Insurable interest is not defined but can be interpreted by the loss to the proposer. Examples of Insurable Interest: Parents on children but children have no interest on parents, Spouse on each other but husband cannot have an insurance on wife unless husband is adequately insured, Employer on employee, Creditors and debtors. Insurable interest should be there at initiation of contact and not at the time of occurrence of event.

Lastly, Insurance Contracts need to be seen from the perspective of Moral Hazard and underwriters need to evaluate each case with an objective of Moral Hazard.

Insurance Samadhan receive many cases of mis-selling, fraud, claim rejection. We use technology filters of above filters and accept case if we find violation on any contract conditions.

At InsuranceSamadhan.com, we have helped resolve over 12,600 customer grievance cases in the past related to all types of Insurance products.

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