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Insurance Consumer Grievances
Redressal of Grievances: Insurance consumer
Protection of Policyholders-IRDA Regulations Grievance Cell of IRDA Consumer Forums Director of Public Grievances(DPG)
There are many agencies available for redressal of grievances of insurance consumers. Grievance cell of IRDA, Insurance Ombudsman, Consumer Disputes Redressal Agencies set up under the Consumer Protection Act 1986, Director of Public Grievances under Govt. of India, are some of the important grievance redressal machineries. Further the safe guards in the interest of insurance consumers, in the form of standing instructions have been provided, for compliance by insurers, under IRDA’s Protection of Policyholders’ Interests Regulations, 2002 IRDA vide their circular no. 37/IRDA/GRM-cir(L)/2009 dated 11-02-2009 has communicated to all life insurance companies that Grievance Redressal Mechanism of insurance companies as well as of Insurance Ombudsman is to be communicated to all policy holders with policy document in a prescribed manner containing addresses, contact no., email ID of office of insurance company, higher official of insurance company and of Insurance Ombudsman. IRDA vide Circular No. 018/AML-CIR/IRDA/E-Payments/July-09 dated 09-07-2009 has allowed payments by Electronic Clearing Service (ECS) and National Electronic Fund Transfer (NEFT) in addition to account payee cheque to life insurance policy holders & beneficiaries.
Insurance consumers face problems concerning non-receipt of premium receipt, non-receipt of policy, non-Renewal, cancellation, transfer of policy, wrong plan & term, nomination, assignment of policies, non-payment of surrender value, maturity value, repudiation of claims, delay in settlement of claims, disputes regarding paid/ payable premium, non-receipt of renewal notices (non-life policies),non-availability of motor third party cover only etc.
Protection of Policyholders-IRDA Regulations
IRDA’s Protection of Policyholders’ Interests Regulations, 2002 prescribes that decision on proposal is to be communicated within 15 days of receipt of proposal to the proposer, copy of proposal to be given to insured within 30 days of acceptance, Grievance Redressal procedure and claim procedure to be communicated to insured with policy document. Life insurance claim to be paid within 30 days of receipt of claim papers otherwise saving bank interest rate to be paid in delays. In non-life claims surveyors to be appointed by insurer within 72 hours of claim intimation, Survey report to be submitted by surveyor within 30 days of date of appointment, Offer of settlement to be given by insurer within 30 days of receipt of survey report and payment of claim to be made within 7 days of receipt of offer of acceptance. Delays in payment by insurer would result in interest payment 2 % above bank rate. Insurer will respond within 10 days of receipt of insured’s communication regarding matters of change of address, nomination & assignments, information on bonus, loan, disbursement of loan, issue of duplicate policy, issuance of endorsement, guidance on procedure of registration & settlement of claim. Please click to see detailed IRDA's Protection of Policyholders’ Interests Regulations, 2002.
Grievance Cell of IRDA(www.irdaindia.org)
Grievance Cell of IRDA does not settles the grievances of insurance consumers but it effectively facilitates speedy settlement. Complainant is required to first approach insurer and if not satisfied then the Grievance Cell of IRDA. Matters regarding delay & non-response pertaining to policies and claims from insurer are taken up by IRDA Cell with the concerned insurer. Complaints are required to be submitted on the prescribed form available at the web site www.irda.gov.in to be sent to:
Grievance Cell of IRDA (Life & Non-Life)Register your complaints online through: Integrated Grievance Management System of IRDA Call Center Toll Free No.155255 Email id: This e-mail address is being protected from spambots. You need JavaScript enabled to view it Address: Insurance Regulatory and Development Authority
Consumer Forums
District Forums in each district of the state, State Commissions in each state of the country and National Commission at Delhi have been set up under The Consumer Protection Act 1986(Amendment 2002) to redress the complaints of consumers.In the consumer courts major segment of complaints pertain to insurance consumers. These Consumer Courts have simplified the adjudication process since nominal fees is charged and complaint can be filed directly by the complainant or through advocate. Complaints of the amount upto Rs.20 lacs can be filed in District Forums, above Rs. 20 lacs and upto Rs.1 crore in State Commission and above Rs. 1 crore in National Commission. Forums decide the case within 3 months from the date of receipt of notice by opposite party. There is a limitation clause of 2 years. Appeals against the awards can be filed within 30 days of date of award. Functioning of State commission & national commission at other places (other than capital/New Delhi ) is allowed. There is provision of stringent enforcement in the Act, in case of non-compliance of Forum’s orders.
Director of Public Grievances(DPG)
Complaints against the public sector insurance companies(LIC,GIC,United India,National,NewIndia,Oriental) can also be lodged with the Director of Public Grievances(DPG) in the Cabinet Secretariate of Govt. of India either online at http://www.dpg.bharatsarkar.nic.in/ or by post at Directorate of public Grievances,cabinet Secretariate,2nd Floor,Sardar Patel Bhawan,Sansad Marg,New Delhi-110001
Insurance ombudsman
It is a Government of India’s machinery for redressal of grievances of insurance consumers. Complaints of insurance consumers pertaining to repudiation, delay in settlement of claims, non-receipt of policy, disputes regarding paid or payable premium regarding their Personal line insurances like Life insurance, motor, mediclaim, householders etc. can be lodged with the Insurance Ombudsman. Complaint is required to be filed in writing, No fees/charges are required to be paid, No advocate is required, Insured is necessarily required to first approach the concerned insurer. Complaint is required to be filed in the office of ombudsman in whose jurisdiction policy issuing office of insurer is located. Complaint may pertain to life or non-life and public or private insurance company. Complaint can be lodged within 1 year of rejection by insurer and it should not be pending in any civil or consumer court. Complaints of the amounts upto Rs.20 lacs can be filed. Ombudsman recommends the settlement of the complaints by mediation within 1 month, Otherwise passes the award within 3 months of receipt of complaint. Award is binding on the insurer but it is not binding on the complainant/insured. There are only 12 offices of ombudsman in country. Offices of Ombudsman are located in the following cities:-
Ahemdabad,Bhopal,New Delhi, Mumbai,Chennai, Hyderabad,Bhubneshwar, Lucknow, Kolkata, Ernakulam, Guwahati,Chandigarh
Awards of Insurance Ombudsman can be seen at http://www.gbic.co.in/synopsis.html
IRDA’s Policy Holder’s Hand Books IRDA has published following hand books for the education of policy holder: 1. Health Insurance 2. Property Insurance 3. Life Insurance 4. Travel Insurance 5. Motor Insurance 6. Insurance Intermediaries These books are available online in English,Hindi,Kannad,Oriya & can be downloaded from the following IRDA’s link: http://www.irda.gov.in/ADMINCMS/cms/frmGeneral_NoYearList.aspx?DF=HBKENG&mid=14.7.1
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