(1)

INSURANCE SECTOR

(A) REDRESSAL OF GRIEVANCES :

In insurance industry, the policyholders’ grievances relate to either rejection of the claim or delay in making the payment or the amount of the payment recommended by the insurance companies. The forums available to the policyholders for redressal of their grievances include grievance cells of insurance companies, civil courts, and Insurance Regulatory and Development Authority (IRDA)

Each company has set up its internal grievance cell at different levels, (i.e., at branch through headquarter-level) where policyholders can register their complaint. The companies are supposed to respond within reasonable period, which is normally a month’s time. In case the consumers do not receive a reply within a reasonable period of time or the reply received is not satisfactory, they can register their complaint at higher levels of authority of the company concerned and go up to the Headquarter level..

Another forum for redressal of their grievances is the institution of Insurance Ombudsman (IO). Any individual policyholder (including a sole proprietor but not partnerships or companies) or his legal heir can approach the IO for complaints in respect of policies on personal lines of business. Personal lines of business include coverage under Personal Accident policies, Medi-claims, insurance of property of the individual such as motor vehicles, etc. There is no fee or charge required to be paid and there is no requirement to approach the Ombudsman through a lawyer. However, before approaching the Ombudsman, a representation should be made to the insurance company concerned. If no reply is received within one month or the reply is not satisfactory, the Ombudsman can be approached. The maximum limit for the amount under dispute for which the Insurance Ombudsman can entertain a complaint is Rs. 20 lakhs and complaints can be made to the Insurance Ombudsman within one year of the rejection by insurer of the representation of the complainant or the insurer’s final reply to the Complainant’s representation. For a list of offices of the Insurance Ombudsman and details of their operations, please visit www.irdaindia.org

All customers including those whose cases do not fall under the purview of the Insurance Ombudsman can approach the District / State and National Consumer Dispute Redressal Forums. For further details kindly visit http://ncdrc.nic.in Besides all these, insurance policies and claims also fall under the jurisdiction of Civil Courts of appropriate jurisdiction.

The Grievance Redressal Cell of the IRDA also looks into complaints from policyholders. Complaints against Life and Non-life insurers are handled separately. The Cell plays a facilitative role by taking up complaints with the respective insurers.

Policyholders who have complaints against insurers are required to first approach the Grievance / Customer Complaints Cell of the insurer concerned. If they do not receive a response from the insurer(s) within a reasonable period of time or are dissatisfied with the response of the company, they may approach the Grievance Cell of the IRDA. Only cases of delay / non-response regarding matters relating to policies and claims are taken up by the Cell with the insurers for speedy disposal.

As claims / policy contracts in dispute require adjudication and the IRDA does not carry out any adjudication, insured are advised to approach the available quasi-judicial or judicial channels, i.e., the Insurance Ombudsman., Consumer Courts or the Civil Courts for such complaints. Only complaints from the insured themselves or the claimants shall be entertained. The Cell doesl not entertain complaints written on behalf of policyholders by advocates or agents or any third parties. Where complaints are being sent through e mail, complainants are required to submit complete details of the complaint as required in the Complaints Registration Form. Without this, the Cell will not be in a position to register the complaint.

Policyholders wishing to register complaints with the IRDA are requested to use the registration form on the website of IRDA.

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