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When you purchase an insurance policy you may have some valid reasons for making a complaint, as you may not be happy with the services of the company or any decision where you feel that the facts have been misrepresented. There may be other reasons for a complaint like a claim being rejected. A person can definitely lodge a complaint to get heard and resolve his grievances. The process is as follows-
1) Complaint to the insurer-
If the policyholder is not satisfied with the company’s procedure or claims settlement he can approach the company to get his grievance addressed. The policyholder can take the help of the agent through whom he has purchased the policy and learn the procedure.
All the companies have a system for receiving, registering, and disposal of grievances. The policyholder can approach the grievance redressal officer at the nearest branch or sent an email to him. The email ids of grievance redressal officers are available on the website of insurance companies.
If the person is visiting the nearest branch they should ensure to give the complaint in writing along with the necessary supporting documents and take acknowledgment of the complaint along with the date. The claims are settled by the company on the basis of information present in the documents submitted in connection with the complaint. It is better to give complete information for faster processing of the complaint.
Insurance companies have their own rules to deal with complaints. The turnaround times are laid in the policy. The company will acknowledge the complaint and give the designation of the officer who will deal with the complaint. The insurer will try to resolve the complaint and send communication regarding resolution. The communication contains the redressal that would be done or the reason why the insurer is rejecting the claim.
The insurance company tries to address the concerned grievance within two weeks and if a person is not satisfied with the resolution provided by the insurer he can take it to the next level and approach the Insurance Regulatory and Development Authority of India (IRDAI).
2) Escalating the complaint to IRDAI-
When the policyholder is unhappy with the solution provided by the insurer he can approach the IRDAI. To monitor the grievance and the turnaround times the IRDAI has implemented the Integrated Grievance Management System (IGMS). The IGMS not only provides online access to the policyholder but also complete control and access to IRDAI for monitoring the issues and resolving grievances. IGMS has a web interface and a mechanism to capture complaints in physical, email, or voice calls received through IRDAI Grievance Call Centre (IGCC). The IGCC can be reached through-
- A toll-free number 1800 4254 732 for voice calls.
- Or a toll-free number 155255 for voice calls.
- An email can be sent at [email protected]
How to use IGMS
- Login to the website https://igms.irda.gov.in/ and create a profile for registering a complaint.
- The policyholder can register one or more complaints.
- The details of the complaint are passed on to the respective insurance company.
- The policyholder receives a confirmation email after registering a complaint with IRDAI along with the token number which will be used by IRDAI and the insurance company for tracking the complaint.
- When the complainant is not satisfied with the solution provided by the insurance company he can escalate the complaint about review by IRDAI. The communications between the Insurer, policyholder, and IRDAI are visible to the complainant.
A complaint letter to IRDAI-
If a person is unable to use the online method he can use the offline method. The address for communication by paper/ fax is-
Insurance Regulatory and Development Authority of India,
Consumer Affairs Department- Grievance Redressal Cell,
Sy. No.115/1, Financial District, Nanakramguda
Gachibowli, Hyderabad- 500032.
3) Approach the Ombudsman-
The Central Government of India created an Insurance Ombudsman, the objective of which was to resolve the complaints in a cost-effective, efficient and impartial manner. There are 17 insurance Ombudsmen in different locations in the country. The Ombudsman, by mutual agreement of the insured and the insurer, acts as a mediator.
The complaint to the Ombudsman has to be given in writing, signed by the insured or the legal heirs, and should be in the jurisdiction where the insurer has a branch/office. It should be supported by the necessary documents. A complaint can be made to the Ombudsman when-
- The complainant has written to the insurance company and it has rejected the complaint.
- The complainant has not received a reply for one month after the insurer received the complaint.
- The complainant is not satisfied with the reply of the insurer.
- Dispute about premium paid or payable in terms of the insurance policy.
- Misrepresentation of policy terms and conditions in the policy document or contract.
- Policy servicing grievance against the insurer and their agent.
- Any other matter resulting from the violations of the provisions of the insurance Act 1938.
Recommendations by the Ombudsman-
There are some protocols that the Ombudsman is expected to follow-
- The recommendations have to be made within one month of receipt of the complaint.
- The copies of the recommendation are sent both to the insurance company and the complainant.
- The recommendations by the Ombudsman have to be accepted by the complainant in writing within 15 days of receipt.
- The copy of the acceptance letter by the insured is sent to the insurer and his written confirmation is sought within 15 days of receipt.
Award by the Ombudsman-
- The Ombudsman will act as a mediator, study the dispute and arrive at a recommendation based on the facts. If the complainant accepts this as a full and final settlement the ombudsman will inform the company which should comply with the terms in 15 days.
If the dispute can’t be settled by intermediation, the Ombudsman will pass the award to the insured which he thinks is fair. The details of the award are –
- The award should not be more than Rs. 20 lakh.
- The award should be within a period of 3 months from the date of receipt of a complaint and the insured must acknowledge the receipt of such award as settlement within one month of the receipt of the award.
- The insurer will comply with the award and inform the Ombudsman in writing within 15 days of receipt of the letter.
Filing a case in the consumer forum of the civil court-
If after following all the above procedures the grievance still stands unresolved and you feel your claim is justified you can approach the consumer forum of a civil court. A complaint can be filed with the Department of Consumer Affairs at the link: https://edaakhil.nic.in/index.html.