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end-user sectionof your health. If any of the statementsyou made is false or incorrect in materialparticulars, or if you have withheldmaterial information, we have a right (i) torefuse payment of your claim, and (ii) toavoid the policy by ending it.2. Allow medical examination,3. Make true statements and fulldisclosure about yourself, your healthand treatment in the claim andrelated documents,4. Follow claim procedure,5. Assist the TPA and us,6. Assist us in claiming indemnity fromthird persons.Suggestions to the insuredThe insured mustknow all these aspectsin the first reading ofthe policy. Policywordings currentlyused do not enablethis.promised insurance cover if has madefalse statements in his proposal. He shouldbe able to take informed decisions fromthe complex information stated in anypolicy.The insured must know all these aspectsin the first reading of the policy. Policywordings currently used do not enablethis. A policy does not make interestingreading at all. It is too much to expect anyperson to read it with interest the secondor third time. On the other hand, theinsurer need not, it is expected, read anypolicy unless the insured has approachedwith some request. Hence the policy mustpresent information “so that in a singlereading [he] can read, understand and act4upon it.” This is the function of plainlanguage.irda journal October 2012The policy can advise the insured aboutsome actions he can take that will givehim an advantage or will avoid himhardship. For example:1. About renewal in time:“It is important that you renew thispolicy before the end of the policyperiod. Such uninterrupted cover willgive you benefits relating to waitingperiod for cover (para ___), cumulativebonus (para ___), and cover for healthcheck-up (para ___).2. About enquiries before treatment:“It is in your interest that before youproceed for treatment you shouldenquire with the TPA or with our officeabout preferred network hospitals.The identity card issued by the TPA willassist you obtain this facility.”3. About contribution:”Thus, if you have a policy fromanother insurance company, we willpay only part of your claim. If you wishto claim the full amount, you mustalso file another claim with thatcompany.”4. About effect of claims:“When we pay any claim to any of you,it will have adverse effect on thepremium and terms of claimspayments when you renew the policy”III. Importance of Plain Language to theInsured and the InsurerIn an insurance policy, the insurer gives apromise of payment in return for thepremium that the insured has alreadypaid. After the policy is issued, any furthersteps under the policy, if at all the needarises, will come from the insured. He hasto take the first action to claim thatpromise. In the language of contract law,the insured ‘has to apply for performance’.After the policy is issued, the insured willbe the first one to read it, and not theinsurer. He will want to know whethercircumstances for making a claim havearisen, and if so, the procedure for makingthe claim. The policy also imposes manyobligations upon him. He must knowthese clearly. The policy imposes manydisabilities, especially for his inaction. He isentitled to know the effect of his actions oromissions. For example, he must knowclearly that he will not receive theThe language of any policy must also beclear to officers of an insurance company.They have to implement the promisesgiven in the policy according to its terms.It is felt that a written contract must beproperly drafted because it must stand inthe court if it is challenged. This is a verynarrow view of the matter. A policy, likeany other written contract, is meant to beperformed. It is a set of instructions for theparties who have made it. It givesdirections about actions to be taken, andthe conditions that apply. It musttherefore give good directions so that itwill be performed in a manner thatsatisfies parties without any need ofadjudication. A well-drafted contractwritten in a language that is easilyunderstood will enable this to happen.IV. Getting over the fear of plainlanguageMoving towards plain language requiresaddressing some concerns that botherthose who are used to complex legallanguage used in policies, or any otherdocument of legal effect.Policies are written by insurers. Policieshave terms stated in language and styleused for many years, sometimes for36
decades. These are therefore ‘established’.Words and style in use for a long timeappear effective. Persons dealing withthat business expect that language. Therecan be anxiety that changing words orterms might change the interpretation ofthe word or term or obligation. Somewords, terms and concepts that arepeculiar to insurance and insuranceindustry cannot be changed. Legallanguage is taken seriously. It isreassuring. Naturally, a person whowishes to make a contract would fear thatsimple or plain words may receive adifferent interpretation than the legalwords they replace.An insurance policy is a contract, andgoverned by the principles ofinterpretation that would apply to anyother contract. When parties differ in theirviews about the meaning of any word orterm used in their contract, or the effect ofthese words on their rights andobligations, a court (or any authority)deciding the matter has to interpret thecontract. For this purpose that court has toascertain the intention of both parties atthe time they made their contract.While interpreting a contract, the judgelooks at the express terms, and will findthe ordinary or natural meaning of wordsas they are written down. The court willgive to words their ordinary meaning, andto technical words their technicalmeaning. Words that have acquired anaccepted legal sense will be interpretedaccordingly. In case of any ambiguity, thecourt will look at surroundingcircumstances, and will also apply thecontra proferentem rule, which allows it tointerpret the contract against the partyrelying on it. An insurance policyexpressed in plain or simple language willbe interpreted by applying the sameprinciples.“There’s no complex, legalistic word thatcan’t be translated into plain English”,5states Rudolf Flesch, who derived theFlesch test that measures readability of apiece of writing. It is stated: “LegaleseAn insurance policy isa contract, andgoverned by theprinciples ofinterpretation thatwould apply to anyother contract.continues because of habit, inertia, fear ofchange, rote use of forms, notions of6uncertainty and lack of skill.” We mustfree ourselves from the anxiety and fear ofshedding legalese.A contract made simpler will still be legaland will have legal effect because partiesintend it to be so. Also, the policy can alsostate expressly:“This policy is written in plain language.We intend that the policy will have fulllegal effect.”1. Section 37 of the Indian Contract Act1872.2. http://www.plainenglish.co.uk/specialist-areas/legal/drafting-in-plainenglish.html3. Rudolf Flesch, How to Write PlainEnglish, Chapter 2, available athttp://www.mang.canterbury.ac.nz/writing_guide/writing/flesch.shtml, visited 30June 2012.4. http://www.plainenglish.co.uk/specialist-areas/legal/drafting-in-plainenglish.htmlvisited 30 June 2012.5. Rudolf Flesch, How to Write PlainEnglish, Chapter 2, available athttp://www.mang.canterbury.ac.nz/writing_guide/writing/flesch.shtml visited 30June 2012.6. Irene Leonard King, What's It Going toTake for You to Use Plain Language?, PlainLanguage Association International,a v a i l a b l e a t h t t p : / /www.plainlanguagenetwork.org/legal/leonard.html visited 30 June 2012Articles and Handbooks1. Peter Tiersma, The Plain EnglishM o v e m e n t ,http://www.languageandlaw.org/PLAINENGLISH.HTM2. Rudolf Flesch, How to Write PlainEnglish, Chapter 2,http://www.mang.canterbury.ac.nz/writing_guide/writing/flesch.shtml3. Plain Language Commission StyleGuide, http://s3-eu-west-1.amazonaws.com/plcdev/files/117/original/PLCstyleguide2Dec2011.pdf4. A Plain English Handbook: How tocreate clear SEC disclosure documents,a v a i l a b l ea thttp://www.sec.gov/pdf/handbook.pdfWebsites1. Center for Plain Language,http://centerforplainlanguage.org2. Plain English Campaign,http://www.plainenglish.co.uk3. Plain English Power: New Zealand,http://www.plainenglish.org.nz4. Plain Language Action andInformation Network,http://www.plainlanguage.gov5. Plain Language Association,http://www.plainlanguagenetwork.org6. Plain Language Australia,http://www.plainlanguageaustralia.com7. Plain Language Commission (UK),http://www.clearest.co.ukThe author is Associate Professor, ILSLaw College, Pune.irda journal October 201237
Page 1 and 2: Volume X, No. 10October 2012Enablin
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'ÃÄ ÃflÃÅ¸Ä¸ÄâÂ§ â¢Ä±âU ÃflâÂ§Äâ Å½ËÄÃÅâÂ§âUÃ¡Ä - IRDA