'ËĘ ÁflÁŸĸĘ∑§ •ı⁄U Áfl∑§Ę‚ Ž˝ĘÁœ∑§⁄UáĘ - IRDA

Simpler wordsWe can use simple, familiar words; and fewer words where possible. However, somedifficult words might require explanation.Policy wording (existing)any notice, direction or instructionconsequent ondetailed in the policyexpenses incurredfollowing expenses are reimbursablehereinafter calledterminateDefinitions as words used in a specificsensePolicies give definitions of words. Thedefinition of a term is a passage thatexplains its meaning. It states the sense ormeaning of that word for the purposes ofthat policy. Such meaning is sometimesartificial.While converting the policy to plainlanguage, we can:1. State that some words or terms have aspecial or technical meaning in thepolicy, and are used in that sense. Thismust become clear to the insured.Thus the policy can use the heading‘Meaning of words’ instead of‘Definitions’, and go on to state thus:Plain language versionany communicationnaturally arising from, naturally arising because ofstated in this policyexpenses you paidwe will pay the following expensesreferred in this policyend“Some words have specific meaningin this Policy. These are as follows: ...”2. Analyse whether a word or termrequires definition, or whether we canallow its ordinary meaning, in whichcase it need not be defined. Forexample, the term ‘accident’ can beleft undefined. However, the term‘Medical Charges’ might requirestatement, viz: “the necessary,reasonable and customary chargesthat you [the insured] pay for medicaltreatment of any illness or bodilyinjury for items of expenses indicatedbelow.”3. List such words or terms with thespecial or technical meaning that weintend to use in the policy. State thespecial meaning in simple language.For example:Short sentencesThe insured, and also the officer of aninsurance company dealing with claims,are required to read the policymeticulously and critically. This requiresattention. Long sentences strain or divertattention, and are hard to read. “Thelonger the sentence, the more ideas yourmind has to hold in suspense until its finaldecision on what all the words mean3together.” If the insured has tounderstand, sentences must be short –not more than twenty words. Eachsentence must give only one idea. Thus along sentence can be broken into manyshort sentences. It can also be stated inbulleted paragraphs.Example 1Before:WHEREAS the insured named in theSchedule hereto has by a proposal anddeclaration dated stated in the Schedule(which shall be the basis of this Contractand is deemed to be incorporated herein)has applied to XYZ Insurance Company(hereinafter called the Company) for theinsurance hereinafter set forth in respectof persons(s) named in the Schedulehereto (hereinafter called the INSUREDPERSON (S) ) and has paid premium to theCompany as consideration for suchinsurance …Word Definition Special meaning(currently used)(in plain language)Deductible means the amount as stated The amount of medicalin Part I of the Schedule, charges that you havewhich has to be borne by agreed to pay yourselfthe insured for every claim before you call on us to pay.before compensation We pay only that part of theunder the policy shall claim that exceeds thisbecome payable.amount. The Deductible inyour case is stated in theSchedule.Third Party any company who has The company we haveAdministrator (TPA) obtained licence from IRDA engaged for providing onto practice as a third party our behalf cashless facilityadministrator and is appointed and other Health insuranceby the company.services under this policy.After:The policyholder made a proposal anddeclaration dated _____. He asked forinsurance under this policy for his healthand the health of persons stated in theSchedule. They all are the insured personsunder this policy. They all have also madedeclarations concerning their health. Thepolicy-holder has paid the premium.Based on the truth of the statements inthe proposal and declarations, we giveinsurance under this policy.(Notes: The policy will define at anotherplace the terms ‘policyholder’ and ‘insuredperson’ and will also state the effect ofnon-disclosure and misrepresentation)irda journal October 201231