How to File a Complaint Against an Insurance Company?

December 23, 2021 Mutual Fund

People usually buy Life Insurance, General Insurance, and Health Insurance policies purely based on the recommendation of their relatives, colleagues, friends, or the insurance company’s representative, which can result in complete dissatisfaction with the services. And, sometimes, even policies bought after proper research can give you an unpleasant experience. There could be many reasons you may not be satisfied with a particular Life Insurance, General Insurance, or Health Insurance company, and you might want to file a complaint against them.

Here are a few common grounds of complaints against a Life Insurance Company:

– Death Claims

– Health Claims (Including Critical Illness)

– Policy Servicing

– Proposal Processing

– Survival Claims

– ULIP Related

– Unfair Business Practices

Here are some of the common grounds of complaints against a Health Insurance Company:

– Claims

– Cover Note

– Coverage

– Policy Related

– Premium

– Product/ Sales Related

– Proposal Processing

– Refund

Here’s how to lodge a complaint against a Life/ General/ Health Insurance Company:

1. Approach the Insurance Company:

Before going anywhere else, you should first approach the insurance company itself to raise a dispute. If you do not get a satisfactory response against your concern from the branch or Customer Care department of the insurance provider, you can approach the Grievance Redressal Officer (GRO) of the insurance company with a written complaint. You may file a complaint to the insurance provider by;

• Visiting the nearest branch of the insurer and submitting a letter duly signed by you (the policyholder) to the GRO at the branch, or

• Writing an email from your registered email id to the official email address of the GRO.

You may get the official email id of the GRO on the insurance company’s official website. In order to save time, it is advisable to submit all the supporting documents along with your complaint itself.

Ensure that you receive the acknowledgment through a letter or an email (as per the communication mode chosen by you) within a reasonable time, which could be used for tracking the complaint or for future reference. The acknowledgement will carry the complaint number, policy number, and the details of the Grievance Redressal Officer who will handle the complaint.

Every insurance provider has its own Grievance Redressal Policy, which can be found on the insurance company’s official website. You may also find the list of grievance redressal policies of all the insurers here.

The insurance company needs to address the complaint within 15 days of receiving it. If you do not receive any response or the resolution is not satisfactory, you may escalate the issue to the next level.

2. Grievance Redressal Cell of the IRDAI:

The Grievance Redressal Cell in the Consumer Affairs Department of the IRDAI takes up the grievances with the respective insurers for redressal. In case of no response or dissatisfactory response from the GRO of the insurance provider, you may approach the Grievance Redressal Cell of the IRDAI.

You can register a complaint with the Grievance Redressal Cell of the IRDAI by;

• Registering an online complaint with the Integrated Grievance Management System (IGMS) – IRDAI Portal at https://www.igms.irda.gov.in. The complaint can be registered through this portal and tracked online for the latest status.

• Sending an email to complaints@irdai.gov.in.

• Calling a toll-free number 155255 or 1800 4254 732.

• Sending a physical form to the IRDAI addressing to:

  General Manager,
  The Insurance Regulatory and Development Authority of India (IRDAI)
  Consumer Affairs Department – Grievance Redressal Cell.
  Sy. No. 115/1, Financial District, Nanakramguda,
  Gachibowli, Hyderabad – 500 032.

The Grievance Redressal Cell handles the complaints filed by the insured or claimants. It does not entertain the complaints filed by advocates, agents, or any other third party on behalf of the policyholder.

Click here to download the Complaint Registration Form. The Grievance Redressal Cell will not be able to proceed to resolve your complaint without the required information asked in the form.

The Turn Around Time (TAT) for each complaint is different and will be communicated to you through the acknowledgement. However, if you are not dissatisfied with the response/ resolution received by the Grievance Redressal Cell, you may raise your concern to the next level.

3. Insurance Ombudsman:

In case of a non-satisfactory response from the insurance provider or the Grievance Redressal Cell of the IRDAI, you can approach the Insurance Ombudsman. The Government of India enforced the Insurance Ombudsman scheme for individual policyholders to settle their complaints out of the court system in a cost-effective, efficient, and impartial way.

At present, there are 17 Insurance Ombudsmen in different locations of the country. Any policyholder who has a grievance against the insurance provider can make a complaint in writing to the Insurance Ombudsman within whose territorial jurisdiction the branch or office of the insurer has complained against, or the residential address or place of residence of the complainant is located.

Unlike the Grievance Redressal Cell, a policyholder himself or their legal heirs, nominee, or appointee can file a complaint.

The Insurance Ombudsman can be approached with the complaint if:

• The insurance company has rejected your complaint.

• The insurance company has not resolved it to your satisfaction.

• The insurance company has not at all responded to your complaint 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.

Your complaint to the Insurance Ombudsman can be about:

• 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 Health insurer.

• Any dispute about premium paid or payable in terms of an insurance policy.

• Misrepresentation of policy terms and conditions at any time in the policy document or policy contract.

• The legal construction of insurance policies in so far as the dispute relates to the claim.

• Policy servicing related grievances against insurers and their agents and intermediaries.

• Issuance of Life Insurance policy, General Insurance policy, including Health Insurance policy, 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. And;

• 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.'

The Settlement Process of the Insurance Ombudsman:

The Ombudsman Settles the complaints in two ways; settlement by recommendation and settlement by the award.

• Settlement by Recommendation:

  The Insurance Ombudsman acts as a mediator and arrives at a fair recommendation based on the facts of the dispute.

  If you (as a policyholder) accept it as a full and final settlement, the Insurance Ombudsman will inform the insurance provider, who will have to comply with the terms in 15 days.

• Settlement by Award:

  If you do not accept the recommendation, the Insurance Ombudsman will pass an award within three months of receiving all the requirements from the complainant, which will be binding on the insurance provider.

  Once the award is passed, the insurance provider shall comply with the award within 30 days of the receipt of the award and intimate about the compliance to the Insurance Ombudsman.

  Click here for the list of names and addresses of the Insurance Ombudsmen.

4. Consumer Forum or Civil Court:

If the complaint is still not resolved, you can approach the Consumer Court. The Consumer Court has a separate department to handle the related grievances of Life Insurance and General Insurance (including Health Insurance).

This article first appeared on PersonalFN here