Nature of complaints in Insurance

Manner of Lodging the complaint :

A) Complainant Proced to the written complaint to the insurer , named in the complaint, and the insurer, when insurer rejected the complaint, or the complainant should not have received any reply, within a period of 1Month .

B) After the insurer has rejected the representation or replied un-satisfsctority complaint has to be made within 1 year period he go for ombudsman.

Award orrecommendation of the ombudsman:

The ombudsman shall make a recommendation, within 1 month from the date of receipt of complaint. the complainant can accept or reject the recommendation.

A) If the complainant accepts the recommendation, the insurance company has to comply with the order, within 15 days, and inform the ombudsman, accordingly.

B) If the complainant does not accept the recommendation, the ombudsman shall pass as award, in writing. The award has to be passed within 3 months. The complainant has to intimate his acceptance of the award within 1 month, by letter of acceptance to the insurance company, and the insurer has to comply , within 15 days, and inform the ombudsman. If the complaint does not intimate the acceptance, the award cannot be implemented.

Complainant can also approach other judicial channel

District Forum

A) Complainant challenges Ombudsman award in District Forum.

B) Complainant direct approach district forum if any claimed under 20 Lakhs.

State Commission

A) Complainant challenged District Form award in State commission .

B) Complainant direct approach State commission if any claimed exceeds 20 Lakhs and does not exceed 1 crore.

National commission

A) Complainant challenged state commission award in National commission.

B) Complainant direct approach National commission if any claimed exceeds 1 crores.

Nature of complaints to Ombudsman

A) Delay in settlement of claims

B) Any dispute on the legal constructions of the policy wordings in case such dispute relates to claims

C) Any dispute with regard to premium paid or payable in term of the policy.

D) Non-issuance of any insurance document to customers after receipt of premium.

Consumerism in insurance

The challenge moves around a consumer awareness and protection and in making products available which consumers can understand better.

IRDAI Established consumer affairs department, to over-see the compliance of insurers and protection of interests of policy-holders.

Note:

Customers complain at email [email protected]

Register and monitor your complaint at

igms.irda.gov.in

www.policyholder.gov.in/addresses-of-ombudsman

https://eco.co.in/ombudsman.html