Are you having trouble with your insurance policy? Here’s how to file a complaint against an insurance company
New Delhi: Problems with the insurance company regarding delays in settling claims, disputes over premiums, and misrepresentation of policy terms and conditions are common. These issues can be resolved by submitting a complaint to the branch’s grievance processing officer. It is the insurance company’s responsibility to respond within 15 days of receiving the complaint.
If the insurance company fails to deal with it within the stipulated time period or provide a satisfactory solution, the complainant can also register his complaint with the Grievance Redress Cell of the IRDA Consumer Affairs Department. If you have a complaint against your insurance company, here are some ways you can file it.
Complaint to the insurance company: In the event of any problem with the insurance policy. The policy holder must first contact the insurance company to address his complaint. You can first contact the Grievance Redress Officer (GRO) at the insurance company. To do this, you can either visit the nearest branch or send an email to GRO. You can easily find the GRO email identifiers for all insurance companies by clicking here.
Note that while contacting the GRO, you need to ensure that you submit your complaint in writing with the necessary supporting documents. Don’t forget to take a written acknowledgment of your complaint with the date. All insurance companies have their own set of rules for managing customer complaints with all relevant details like contact and how to escalate the issue.
Wait for the solution: According to IRDAI guidelines, the insurance company should ideally address your concerns within 15 days. However, if your complaint is not resolved within 15 days, or if you are not satisfied with the solution provided by the insurance company, you can escalate the issue to the next level. You can register your complaint with the insurance regulator, the Insurance and Development Regulatory Authority of India (IRDAI).
Escalate to IRDAI: At present, you can easily contact the IRDAI Department of Consumer Affairs’ grievance cell by calling toll-free 155255 (or) 1800 4254 732 or by sending an e-mail to complaints@irdai.gov.in. You also have the option to use an online portal operated by IRDA called the Integrated Grievance Management System (IGMS).
This route should only be used after you have tried the grievance processing channel of the relevant insurance company. If for any reason you cannot reach the insurance company directly, IGMS provides a portal for registering complaints with insurance companies.
How to file a complaint via the IRDAI portal:
A complainant can submit a new complaint or escalate it to the Integrated Grievance Management System (IGMS) by visiting the website igms.irda.gov.in, using IRDA’s online complaint processing portal. IGMS allows the complainant to amend his complaint midway. Make sure that before you contact IRDA, you must register a complaint with the relevant insurance company.
This can also be done either by calling the toll-free number 155255 (or) 1800-4254-732 or by sending an email to complaints irda.gov.in.
After receiving the complaint, a token number will be generated and given to the complainant. It will be transferred to the insurance company for re-examination and response within two weeks. If the response received is not satisfactory, the complaint is escalated to the insurance ombudsman, consumer forum or civil court based on the nature of the complaint.
In the event that the complaint has not been fully processed by the insurance company within 15 days of submission, you can use IGMS to escalate the complaint to IRDAI.
Send a message to IRDAI: If you are unable to use the online routes, you can use the offline route. The policy holder must download the complaint registration form available on the IRDA website. Fill out the form and send it with relevant documents to the Director General, Department of Consumer Affairs, Grievance Redress Cell, IRDA.
The complaint may be submitted on a paper duly signed by the complainant, which clearly states the name and address of the complainant, the name of the branch or office of the insurance company against which the complaint is to be registered, and the reason for the complaint. Along with the supporting documents, the nature and extent of the loss suffered by the complainant and the relief required of the insurance Ombudsman (the organization that deals with complaints).
You can send your complaint via express mail or send it to the following address:
Director general
Consumer Affairs Department – Grievance Handling Cell
Insurance Regulatory and Development Authority of India (IRDAI),
Sy. No.115/1, Financial District, Nanakramguda,
Gachibuli, Hyderabad 500032
Insurance Ombudsman: If your complaint is not dealt with to your satisfaction, you can turn to the Appeals Authority or the Insurance Ombudsman. The Insurance Complaints Trustee Scheme was established by the government for individual policyholders to settle their complaints outside the court system in a cost-effective, efficient and impartial manner.
Currently, there are 17 insurance ombudsmen located in various locations across the country and anyone who has a complaint against the insurance company, can himself or through his legal heirs, nominee or assigns submit a written complaint to the insurance ombudsman whose territorial jurisdiction is located The branch or office of the insurance company against which the complaint is made, or the complainant’s residence address or place of residence.
There are some conditions that you must comply with before going to the insurance ombudsman. IRDA’s consumer education website https://www.policyholder.gov.in/ stated that you should first contact your insurance company about a complaint. However, if they refuse the matter, do not resolve it to your satisfaction, or do not respond to it at all for 30 days, you can contact the insurance ombudsman. Your complaint must be related to a policy taken by you in your individual capacity and the value of the claim including the claimed expenses should not be more than 30 lakh rupees.
The Ombudsman will act as a mediator and will reach a fair recommendation based on the facts of the dispute. If you accept this as a full and final settlement, the Ombudsman will notify the company that it must comply with the terms within 15 days.
However, if settlement by recommendation is not successful, the Ombudsman will pass an award within 3 months of receiving all requirements from the complainant that will be binding on the insurance company. Once the award is passed, the insurance company must comply with the award within 30 days of receiving the award and inform the ombudsman of its compliance.
File a case in a consumer forum or civil court: If your complaint remains unresolved after following all of the above methods and you feel your claim is justified, you have the option of contacting a consumer forum or a civil court. For example, you can file a complaint with the Ministry of Consumer Affairs.
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