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Executive Summary: If you have a grievance against your insurance company, you must first approach your insurer. Lodge the complaint in writing and take an acknowledgement. In case the insurer does not reply within 15 days or if you are unhappy with the response, you can take the complaint to IRDA. In certain cases, you can also approach the Insurance Ombudsman to reach a settlement for the dispute. Despite the availability of grievance redressal mechanisms, you must be proactively alert while dealing with your insurance policy.
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Having a grievance or complaint with your insurance company is not new. This can either be before buying the policy with respect to agents or delivery of the policy document or it can be after you buy the policy relating to policy servicing or claim settlement. In recent times, it is seen that there are increasing number of grievances being lodged with insurance companies. IRDA, the insurance regulator has viewed customer grievances quite severely and has specified the steps to raise a grievance in this respect. As a customer, here’s what you should do if you wish to raise an insurance grievance:
- First, you must approach the insurer’s consumer grievance cell. The Grievance Redressal Officer or the GRO handles complaints and grievances of customers. Details of the GRO can be obtained from the nearest branch or any other office of the insurer. You can also obtain details of the Grievance Redressal Officers by clicking here. It is always advisable to file the complaint in writing and attach the necessary documental evidence, if applicable. Remember to take an acknowledgement of the complaint.
- If the insurance company does not solve your grievance, you can next lodge the complaint with IRDA. This is usually when the insurance company does not reply to your complaint or if you are unhappy with the insurer’s response. You must approach IRDA’s Grievance Redressal Cell of the consumer affairs department. The complaint can be lodged by (a) calling IRDA’s toll free number at 155255 or 1800 4254 732 or (b) by mailing them at [email protected] or (c) by writing to them at Consumer Affairs Department, Insurance Regulatory and Development Authority, 3-5-817/818, United India Towers, 9th Floor, Hyderguda, Basheerbagh, Hyderabad or (d) Sending a fax to 040-66789768. The complaints are registered free of cost by IRDA. You can also register a complaint by logging on to http://igms.irda.gov.in/ – the Integrated Grievance Management System (IGMS) portal of IRDA. Set up by IRDA in 2011, the IGMS helps a consumer to file a complaint online and track it as well. IRDA will then forward the complaint to the concerned insurer. If, within 15 days, the insurance company does not resolve the complaint, the policy holder can again complaint to IRDA. If there is a reply from the insurer, but the policy holder is unhappy with this, then the complaint can be lodged again with IRDA or he can approach the civil court or consumer forum. IRDA also makes enquiries wherever required.
- There are some cases when you can approach the Insurance Ombudsman if your insurer does not give a satisfactory response of there is no reply from the insurer for 30 days from the date of first filing a complaint. The nature of the complaint should be applicable to be taken to the Insurance Ombudsman. Usually complaints related to claims are eligible to be taken to the Ombudsman. So what is the Insurance Ombudsman? This is a scheme which has been created to settle complaints without approaching courts. There are twelve Insurance Ombudsmen in the country. You will need to check the location which is applicable to file the complaint. Acting as a mediator, the Insurance Ombudsman specifies a settlement for the grievance. If this is acceptable to you, the insurer should agree to the terms within 15 days. Details regarding the nature of complaints to be filed with the Ombudsman and the settlement process can be obtained by clicking here.
Let’s learn to raise an insurance grievance
Although there are various stages of grievance redressal mechanisms which are available, as a policy holder, you must be proactively alert while dealing with your insurance policy. For example, understand policy terms, charges and other conditions before taking the policy. Do not hesitate to enquire with your insurer or the agent if you have any clarifications. Check the credentials of the agent before you engage one. Make all necessary disclosures before taking the policy. Get written communication on promises made by the insurer or agent. Check your policy statements regularly. Inform the insurer immediately if there is a claim and submit the documents relating to this promptly in order to avoid delays. And the most important thing to be kept in mind is to maintain evidence for all your correspondence with the insurer. Taking small efforts can go a long way in getting your grievances addressed promptly and avoiding one if possible
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