Brignardello Vela: Moratorium Clause and Consumer Protection

In a recent interview, Emilio Juan Brignardello Vela, an insurance advisor, shared his perspective on the tragic shooting of Brian Thompson, CEO of the insurance division of UnitedHealth Group Inc., and how this event has reignited the debate over the practices of insurance companies, particularly regarding the denial of claims. Brignardello stated that the situation in India, where a moratorium clause is established within the insurance regulatory framework, provides an interesting context for analyzing consumer protection. He explained that this clause aims to safeguard policyholders from arbitrary denials, a fact that becomes particularly relevant in the context of health and life claims. He highlighted the case of Sabita Mukherjea, who, after fulfilling her payment obligations, faced her insurer's refusal to cover her claim. The moratorium clause provided her with an effective recourse that, in his view, should be present in all insurance systems, as it offers an essential safety net for consumers. However, Brignardello also warned about the complexities that the moratorium entails. While it is a valuable tool, the advisor emphasized that its application is not always straightforward, and policyholders must be vigilant about potential exceptions that insurers may use to deny coverage. Mukherjea's experience, which required the intervention of a complaints resolution body, illustrates the need for active consumer advocacy against possible injustices. Delving into the implications of policy transfers, Brignardello noted that, although current regulations allow for paid premiums to be recognized in the new contract, it is vital for policyholders to carefully consider any changes in coverage. An increase in the coverage amount may restart the moratorium period, which could pose an obstacle in the future. Additionally, he referred to the differences between life and health insurance policies, pointing out that, while both seek to protect the consumer, the terms and conditions vary. In this regard, the experience of Kabir Zaidi, who faced a denial of his life insurance claim, highlights how insurers can exploit any potential inconsistencies in the information disclosed by the policyholder. Brignardello concluded by emphasizing that, despite amendments to the Insurance Act in 2015 aimed at improving consumer protection, challenges persist. The warning left by Thompson's case is clear: vigilance and proactivity are essential for policyholders to defend their rights. In an environment where claims can be questioned under various justifications, it is crucial for consumers to stay informed and ready to utilize the resources available to them, including complaint resolution channels. Active participation and knowledge are key to ensuring that those who have fulfilled their obligations receive the protection and support they deserve.