How do you file a complaint when there’s an oversight or negligence on the part of your insurance company? We’ll tell you all about it here!
If you’re familiar with the entire process of lodging banking complaints with the RBI’s Banking Ombudsman, that’s fantastic! However, imagine pooling your life savings in a Health Insurance policy, only to be left short-changed at the end of the policy term because of a lapse or negligence on the part of the insurance company.
As if dealing with an illness isn’t enough, you now have to run from pillar to post to be able to get back your own money. Doesn’t make for a pleasant scenario, does it?
Thankfully, you don’t have to waste any time running around seeking redressal of your grievances against your insurer. To tackle situations like these, the Insurance Regulatory and Development Authority of India (IRDAI) has created the Insurance Ombudsman Scheme.
By way of this scheme, “individual policy holders can have their complaints looked into and settled out of the courts in a cost-effective, efficient and impartial way”.
Additional reading: Health Insurance Policy: How To Make The Right Choice
What is the IRDAI?
The IRDAI is an autonomous body set up under the IRDA Act, 1999. It was set up with the primary objective of protecting the interests of policyholders and to regulate and develop the insurance industry.
The powers, functions, and duties of the IRDAI are as follows:
- Registering and regulating insurance companies
- Protecting policyholders’ interests
- Licensing and establishing norms for insurance intermediaries
- Promoting professional organizations in insurance
- Regulating and overseeing premium rates and terms of non-life insurance covers
- Specifying financial reporting norms of insurance companies
- Regulating investment of policyholders’ funds by insurance companies
- Ensuring the maintenance of solvency margin by insurance companies
- Ensuring insurance coverage in rural areas and of vulnerable sections of society.
Additional Reading: Steps To Follow While Filing A Complaint Against Your Health Insurer
How to file a complaint against your insurer with respect to Life Insurance as well as non-Life Insurance policies?
If you have a complaint that needs to be addressed by your insurance company, here’s what you need to do:
- Send a written complaint along with the necessary supporting documents to the Grievance Redressal Officer of your insurance company’s branch or any other branch that you deal with. You can find mail IDs of Grievance Redressal Officers (GROs) of all insurance companies online. Make sure you get a written acknowledgment of your complaint with the date.
- In case your insurance company doesn’t resolve your complaint within 15 days, or if you’re not satisfied with their response, you can opt for any of following steps:
- Contact the Grievance Redressal Cell of the Consumer Affairs Department of IRDAI: You can call their toll free number 155255 (or) 1800 4254 732 or send an email to complaints@irda.gov.in
- Use IRDAI’s online portal-Integrated Grievance Management System (IGMS):
Register and monitor your complaint at igms.irda.gov.in. Once the complaint is registered, you will be allotted a token reference number.
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Approach the Insurance Ombudsman or civil court:
If you’re still not satisfied with the resolution, you can escalate the matter by approaching the Insurance Ombudsman or file a civil complaint against the insurer before a civil court.
Additional reading: How To Claim Insurance Money-A Step-By-Step Guide
What is the Insurance Ombudsman?
As stated earlier, the Insurance Ombudsman scheme was created by the IRDAI to address complaints relating to both Life and non-Life Insurance by individual policyholders. This means that you can approach the Insurance Ombudsman for any kind of insurance complaints, be it Home Insurance, Life Insurance or any other insurance policy.
At present, there are 17 Insurance Ombudsman offices in 17 locations across the country and any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee, make a written complaint to the Insurance Ombudsman within whose territorial jurisdiction the branch, office, residential address or place of residence of the insurer is located.
You can find the names of the Insurance Ombudsman and contact details of the Insurance Ombudsman centres here.
You can approach the Insurance Ombudsman with a complaint if you have first approached your insurance company with the complaint and:
-They have rejected it
-Not resolved it to your satisfaction or not responded to it at all for 30 days
-Your complaint pertains to any policy you have taken in your capacity as an individual
-The value of the claim, including expenses claimed, is not above Rs. 30 lakhs.
Additional Reading: How To File An Appeal Against An Insurance Claim Denial
Types of complaints that you can register with the Insurance Ombudsman:
- Delay in settlement of claims, beyond the time specified in the regulations, framed under the IRDAI Act, 1999.
- Any partial or total repudiation of claims by the Life Insurer, General Insurer or the Health Insurer.
- Any dispute about premium paid or payable in terms of insurance policy.
- Misrepresentation of policy terms and conditions at any time in the policy document or policy contract.
- Legal construction of insurance policies in so far as the dispute relates to claim.
- Policy servicing related grievances against insurers and their agents and intermediaries.
- Issuance of Life Insurance policy, General Insurance policy including Health Insurance policy, which is not in conformity with the proposal form submitted by the proposer.
- Non-issuance of insurance policy after receipt of premium in Life Insurance and General Insurance including Health Insurance
- Any other matter resulting from the violation of provisions of the Insurance Act, 1938, or the regulations, circulars, guidelines or instructions issued by the IRDAI from time to time, or the terms and conditions of the policy contract in so far as they relate to issues mentioned in clauses (a) to (f).
How does the settlement process work?
After you approach the Ombudsman with your complaint, the following actions will be taken by the Ombudsman:
- The Ombudsman will act as a mediator and arrive at a fair recommendation based on the facts of the dispute.
- If you accept this as a full and final settlement, the Ombudsman will inform the company which should comply with the term in 15 days.
If the settlement by recommendation doesn’t work, the Ombudsman will pass an award within 3 months of receiving all the requirements from the complainant, which will be binding on your insurer. The insurer shall comply with the award within 30 days of the receipt of the award and intimate the compliance of the same to the Ombudsman.
Additional reading: Term Insurance Plans With The Best Claim Settlement Ratios In India
Insurers’ Grievance Redressal Policies
The IRDAI has mandated that each insurance company should specify and make public the way it deals with consumer complaints and resolves them.
Points to remember:
- Before approaching the IRDA, remember to first approach your insurance company to lodge your complaint.
- The IGMS system also allows policyholders to amend complaints midway.
- Remember to take a written acknowledgment of your complaint when you approach your insurer for redressal.
- After filing your complaint with IGMS, remember to keep your token reference number safe with you. You will need it when you’re following up on your complaint.
We hope that this article was able to throw some light on how to go about filing an insurance complaint. If you’re interested in acquiring an insurance policy or any other financial products, you’ve certainly come to the right place!