Policy schedule, policy wording or brochure: which one actually counts?

Your contract is the policy wording read together with your schedule and any endorsements issued since. The Customer Information Sheet is a summary — where it conflicts with the policy document, the policy document prevails — and the brochure or prospectus is sales material, not the contract. Your proposal form counts too: it records what you declared, and the insurer uses it to decide whether to accept the risk and on what terms.

It is easy to keep whichever document arrived last and read only that. When a claim is in dispute the question is narrower: which document holds the term the insurer is relying on, and which one wins if two of them disagree? Here is how the pieces fit together.

What each document is for

The table follows how one insurer's health wording puts it: it defines 'Policy' as the policy wordings, the schedule and any applicable endorsements, and says the wording and schedule are to be read together as one document. Check the definition of 'Policy' in your own wording.^[1]

The schedule holds your numbers

A wording can explain a rule and leave the figure to the schedule. One insurer's standard car policy, for example, says the insurer is not liable for the deductible 'stated in the schedule'. A health policy must state the date from which you have been continuously covered without a break, which matters when your waiting periods are counted. If a number in your schedule is wrong, have it corrected by endorsement — see correcting a mistake in your policy.^{[3, 2]}

When two documents disagree

1. The CIS and the wording: IRDAI's own CIS format says that in case of any conflict, the terms and conditions in the policy document prevail. Use the CIS to find the clause, then read the clause.^[2]
2. The schedule and the wording: They are read together: the wording supplies the rule, the schedule your particulars. A standard motor wording says in terms that the policy and the schedule shall be read together.^[3]
3. An endorsement and the original schedule: An endorsement records a change the insurer has made. In one insurer's wording only the company can modify the policy, and any change must be evidenced by a written endorsement signed and stamped — so, under such a wording, a promise from an agent that was never endorsed has not changed the policy.^[1]
4. The policy and your proposal form: A standard car wording makes the proposal the basis of the contract. If the policy issued does not match the proposal form you submitted, that mismatch is itself one of the grounds on which the Insurance Ombudsman can receive a complaint, once the insurer has rejected your written complaint, not replied within one month of receiving it, or replied unsatisfactorily.^{[3, 5]}

If the brochure promised more than the wording gives

A prospectus is a document issued to sell or promote the product, and the insurer must make sure the information it gives presents a true and correct picture of the features, benefits and exclusions. If you bought on the strength of a brochure or a salesperson's statement that the wording does not support, the claim is assessed against the policy — one insurer's wording, for example, says the policy constitutes the complete contract of insurance. The gap is a separate complaint about mis-selling, which includes making a false or misleading statement or misrepresenting the benefits.^{[4, 1]}

Keep the brochure, any screenshots and the messages from the time of sale, and raise it in writing with the insurer. Complaining about a mis-sold policy explains the route.

You should not have to ask twice for the core documents: within 15 days of accepting your proposal, the insurer must give you the policy document, a copy of your proposal form and the CIS.^[2]

ClaimAssure is an independent private platform. It is not an insurer, IRDAI, Bima Bharosa or the Insurance Ombudsman, it never files anything on your behalf, and it cannot promise any outcome. What it does is read your documents and show you what they say.

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