INSURANCE
Welcome to A. Maitra & Co. Associates. We understand that insurance-related disputes can be complex and stressful. Our dedicated team of legal is here to guide you through the process with expertise and compassion. By choosing us, you ensure that your rights are protected and that you receive the best possible outcome for your case.
INSURANCE POLICY & CLAIMS
An insurance policy is a legal contract between the insurer (insurance company) and the insured (policyholder).
The insurer agrees to provide financial protection against specified risks, and the policyholder agrees to pay a premium.
Example:
You buy a health insurance policy for ₹5 lakh and pay an annual premium. If you suffer a covered hospitalization, the insurer may pay the eligible medical expenses according to the policy terms.
An insurance claim is a formal request made by the insured or beneficiary to the insurance company for payment or benefits after an insured event occurs.
Example:
A factory's insured machinery is damaged in a fire → the policyholder reports the loss → submits documents → insurer investigates → the claim is approved, partially approved, or rejected according to the policy.
A claim may be rejected when, for example:
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The loss is specifically excluded by the policy.
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The policy had expired or was not active.
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Required information was deliberately misrepresented.
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The incident falls outside the insured risk.
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Required claim procedures were not followed.
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The claimed loss cannot be established with sufficient evidence.
Book Meeting
"I recently had the pleasure of working with this law firm and was thoroughly impressed with their professionalism and expertise. Their team of lawyers is highly knowledgeable and dedicated to achieving the best possible outcome for their clients. They were able to guide me through the legal process with ease and made sure that my rights were protected every step of the way. I would highly recommend them to anyone in need of legal services."
Gaurav Singh, Jaipur (Rajasthan)
INSURANCE FRAUD
Insurance fraud means deliberately providing false, misleading, or concealed information to an insurance company in order to obtain a financial benefit to which a person is not legally entitled.
It can be committed by policyholders, claimants, intermediaries, service providers, or sometimes insiders within an insurance company.
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False claim – Claiming that an accident, theft, illness, or damage occurred when it did not.
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Inflated claim – A genuine loss occurs, but the claimant deliberately exaggerates its value.
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Staged accident – An accident is deliberately created to obtain insurance money.
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False documents – Submitting fabricated bills, medical records, invoices, or other evidence.
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Non-disclosure or concealment – Deliberately hiding material information when taking a policy.
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Multiple claims – Attempting to recover the same loss from several insurers without lawful entitlement.
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Identity or policy fraud – Using another person's identity or policy information to obtain benefits.
Insurers may examine:
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Claim forms and supporting documents
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Medical records and bills
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Accident reports
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Previous claims history
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Inconsistencies in statements
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Damage assessments and surveys
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Transaction and policy records
Depending on the facts and applicable law, insurance fraud can result in:
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Claim rejection or repudiation
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Cancellation of the policy
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Recovery of money already paid
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Civil liability
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Criminal prosecution, fines, or imprisonment
INSURANCE & BANKS
Insurance and banks are two important parts of the financial system. They are different institutions, but they often work together to provide financial security and services to customers.
A bank is a financial institution that primarily accepts deposits, provides loans, facilitates payments, and offers other financial services.
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Savings and current accounts
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Fixed deposits
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Personal, home, education, and business loans
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Credit/debit cards
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Online payments and transfers
Banks and insurance companies often cooperate through bancassurance.
Bancassurance means the distribution of insurance products through a bank's network or customer channels.
