Insurance Grievances - What to do?

Written on Tuesday, July 28, 2015
By Team Bajaj Capital

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You carefully selected an insurance scheme, submitted a complete list of documents while purchasing policy, furnished every information with utmost truth, have been paying your premiums on time and now, you have got all the rights to reap benefits when in need. But what if your insurer decided to reject your claim citing some lame reason or change in terms of agreement without you being notified? You would very likely get annoyed and feel miserable, but there is no need to keep mum if you feel you have been cheated. The Insurance Regulatory and Development Authority of India (IRDAI), has designed a strict set of guidelines for insurers to handle customer complaints.

Things you need to know
-Upon filling a grievance, insurer needs to send a written acceptance within three working days.

-The acknowledgment should contain the name and designation of officer taking care of your complaint.

-It should also have the detailed process of grievance redressal.

-In case your complaint gets rejected within two weeks of filling, insurer has to furnish valid reasons.

-It is the duty of insurance company to guide policy holder about available alternatives.

If the insurance company fails to follow mentioned guideline, insurer can file a complaint with IRDA by simply contacting the Call Centre over phone (Toll-Free 1800 4254 732). One can even register the issue online through IRDA's Integrated Grievance Management System. This is not it; the regulator has armed you with several other options to get your grievance addressed and to make sure you get what you deserve. Now you know the initial procedures but what if you have not yet received a satisfactory solution.

Here, we guide you with steps ahead

1. Insurance Ombudsman:
You can approach the office of insurance ombudsman, which have been established in 12 cities all over India, each with its own jurisdiction. You have to approach the Ombudsman under whose jurisdiction the insurance company office against whom you are making a complaint falls. The body has been equipped with powers to redress cases not exceeding 20 Lakh and it can reward compensation to complainant. Policy holder can take this step after 30 days of filling the initial complaint with the principal company.

We have compiled the list of cities having ombudsman office and their jurisdiction.


City Jurisdiction

Ahmedabad

Gujarat, Union Territories of Dadra & Nagar Haveli, Daman & Diu

Bhopal

Madhya Pradesh and Chhattisgarh

Bhubaneswar

Orissa

Chandigarh

Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir, Chandigarh

Chennai

Tamil Nadu, Pondicherry Town and Karaikala

Delhi

Delhi and Rajasthan

Guwahati

Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura

Hyderabad

Andhra Pradesh, Karnataka and Yanam

Kochi

Kerala, Lakshadweep and Mahe

Kolkata

West Bengal, Bihar, Sikkim, Jharkhand, Andaman & Nicobar Islands

Lucknow

Uttar Pradesh and Uttarakhand

Mumbai

Maharashtra and Goa


2. Consumer Court: If a policy holder has been through all the channels has not got his due, consumer court is the last resort. You should prefer this option only after a reply from the office of Ombudsman. Approaching consumer court is a simple and fast process, which can award compensation to the policy holder. It is also one of the most economical solutions.

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