Most of us have experiences of insurers, who have not provided us good services at some point of time. For instance, the insurance company’s staff was rude to us, didn’t explain things in a right manner or refused a claim. Insurance companies are like any other business and therefore you can file a complaint against them if you are not satisfied with their services. Filing a complaint also helps you, to make sure that next time you won’t have any bad experience with them. However, filing a complaint against an insurance company is “not” a quick process.
Approach the grievance cell of the insurer
If you have any grievance against an insurer, you need to first approach the grievance redressal officer of the insurer’s branch or any other office that you deal with. Make sure you are filing the complaint in writing with the necessary supporting documents. Also ensure that you have a“written acknowledgment of your complaint” with the date. The insurer has to acknowledge the complaint within three days and resolve it within 15 days.
If you are not satisfied, file complaint with the IRDA
If you don’t get any response from the insurer or you are not happy with the solution, then you can approach the grievance redressal cell of the consumer affairs department of IRDA (Insurance Regulatory and Development Authority). You can call the toll free number 155255 or send an e-mail to firstname.lastname@example.org
For details of grievance cell of the IRDA, please visit IRDA website http://www.irdaindia.org/grievancescell.htm
Send a letter/fax to IRDA:
Consumer Affairs Department
Insurance Regulatory and Development Authority
3-5-817/818, United India Towers, 9th Floor
Hyderabad – 500029
Filecomplain online on IGMS
You can also make use of the Integrated Grievance Management System (IGMS) — http://www.igms.irda.gov.in
The IGMS facilitates online registration of policyholders’ complaints and helps track their status.
Swapan Khanna, co-founder, i-save, says, “The system has an inbuilt workflow that assigns and tracks unique complaint IDs and also initiates pre-defined actions/intimations to all parties involved. Customers can lodge a complaint against an insurer (both life and non-life), a broker or an intermediary in respect of any sales, servicing or claims related issues.” He adds, “Make sure you provide all relevant details like your proposal/policy number, your contact details, name of the insurer etc. to aid in a timely resolution of your complaint.” i-save is an independent provider of information, research and analysis on insurance and personal finance.
Approach an ombudsman or a consumer forum
If you didn’t receive any response (in 15 days) or you are not happy with the solution provided by the insurer, then you can lodge a complaint with insurance ombudsman. Again, the complaint has to be in writing, along with the necessary documents. It should be addressed to the insurance ombudsman of the jurisdiction under which the office of the insurer falls. The complaint can also be filed through the legal heirs of the insured. The insurance ombudsman is an independent office to provide speedy and cost effective resolution of grievances to the customers. Please click on the below link, to refer to the list of insurance ombudsmen office in India: http://www.irdaindia.org/ombudsmen/ombudsmenlist_new.htm
Mr Khanna adds, “While the process may not be exceptionally quick,the important consideration is that the award (recommendation) of the ombudsman is binding on the insurance companies while the complainant can choose to approach other bodies such as consumer forums or courts of law.”
Territorial jurisdiction of ombudsman
There are 12 ombudsmen appointed across the country allotting them different locations as their areas of jurisdiction. The ombudsman may hold sitting at various places within their area of jurisdiction to speed up disposal of complaints. The offices of the twelve insurance ombudsmen are at (1) Bhopal (2) Bhubaneswar (3) Cochin (4) Guwahati (5) Chandigarh (6) New Delhi (7) Chennai (8) Kolkata (9) Ahmedabad (10) Lucknow (11) Mumbai (12) Hyderabad.
Recommendations of ombudsman
When a complaint is settled by an ombudsman, he shall make recommendations which he thinks are fair in the circumstances of the case. Such a recommendation shall be made with one month of the complaint received and copies of the same will be sent to you and the insurer. If you accept the recommendations,you should send a communication in writing in 15 days of the date of receipt accepting the settlement.
Power of ombudsman
Ombudsman’s power is restricted to insurance contracts of value not exceeding Rs. 20 lakh. If you are not satisfied with the recommendation/solution of the ombudsman,you can approach other venues like consumer forums and courts of law for redressal of grievances.
Thus,if you have a complaint against an insurer, then you should first approach the grievance/customer complaints cell of the insurer. If you do not receive a response from insurer within 15 days or are dissatisfied with the response provided, you may approach the grievance cell of the IRDA. If still not satisfied,you can take the matter with the ombudsman or a consumer forum.