How to make a complaint – If you are unhappy with your insurance company

First thing to do is Approach the Insurance Company’s Grievance Redressal Officer of its branch or any other office that you deal with. Click here for mail ids of Grievance Redressal Officers, GRO, of all insurance companies

  • Give your complaint in writing along with the necessary support documents
  • Take a written acknowledgement of your complaint with the date.

The insurance company should deal with your complaint within 15 days.

  • If that does not happen or if you are unhappy with their solution you can:
    • Approach the Grievance Redressal Cell of the Consumer Affairs Department of IRDA:Call Toll Free Number 155255 (or) 1800 4254 732 or
    • Make use of the Integrated Grievance Management System:
  • Send a letter or fax to IRDA with your complaint:
    • Click here to download Complaint Registration Form
    • Fill and send by post or courier to:
      Consumer Affairs Department
      Insurance Regulatory and Development Authority
      3-5-817/818, United India Towers, 9th Floor
      Hyderguda, Basheerbagh
      Hyderabad – 500 029
    • Or Fax to
      040-66789768

Integrated Grievance Management System

IRDA has launched the Integrated Grievance Management System (IGMS). Apart from creating a central repository of industry-wide insurance grievance data, IGMS is a grievance redress monitoring tool for IRDA. Policyholders who have grievances should register their complaints with the Grievance Redress Channel of the Insurance Company first. If policyholders are not able to access the insurance company directly for any reason, IGMS provides a gateway to register complaints with insurance companies.

Complaints shall be registered with insurance companies first and only if need be, be escalated them to IRDA (Consumer Affairs Department). IGMS is a comprehensive solution which not only has the ability to provide a centralised and online access to the policyholder but complete access and control to IRDA for monitoring market conduct issues of which policyholder grievances are the main indicators. IGMS has the ability to classify different complaint types based on pre-defined rules. The system has the ability to assign, store and track unique complaint IDs. It also sends intimations to various stakeholders as required, within the workflow. The system has defined target Turnaround Times (TATs) and measures the actual TATs on all complaints. IGMS sets up alerts for pending tasks nearing the laid down Turnaround Time. The system automatically triggers activities at the appropriate time through rule based workflows.

A complaint registered through IGMS will flow to the insurer’s system as well as the IRDA repository. Updating of status will be mirrored in the IRDA system. IGMS enables generation of reports on all criteria like ageing, status, nature of complaint and any other parameter that is defined.

Thus IGMS provides a standard platform to all insurers to resolve policyholder grievances and provides IRDA with a tool to monitor the effectiveness of the grievance redress system of insurers.

Ombudsman

The Insurance Ombudsman scheme was created by Government of India for individual policyholders to have their complaints settled out of the courts system in a cost-effective, efficient and impartial way.
There are 17 Insurance Ombudsman in different locations and you can approach the one having jurisdiction over the location of the insurance company office that you have a complaint against.
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You can approach the Ombudsman with complaint if:

  • You have first approached your insurance company with the complaint and
    • They have not resolved it
    • Not resolved it to your satisfaction or
    • Not responded to it at all for 30 days
  • Your complaint pertains to any policy you have taken in your capacity as an individual and
  • The value of the claim including expenses claimed is not above Rs 20 lakh

Your complaint to the Ombudsman can be about:

  • Any partial or total repudiation of claims by an insurer
  • Any dispute about premium paid or payable in terms of the policy
  • Any dispute on the legal construction of the policies as far as it relates to claims
  • Delay in settlement of claims
  • Non-issue of any insurance document to you after you pay your premium
The settlement process

Recommendation:

The Ombudsman will act as counsellor and mediator and

  • Arrive at a fair recommendation based on the facts of the dispute
  • If you accept this as a full and final settlement, the Ombudsman will
  • Inform the company which should comply with the terms in 15 days

Award:

  • If a settlement by recommendation does not work, the Ombudsman will:
  • Pass an award within 3 months of receiving the complaint and which will be
    • A speaking award with the detailed reasoning
    • Binding on the insurance company but
    • Not binding on the policyholder
  • The Ombudsman can also award an ex-gratia payment

Once the Award is passed

  • You have to accept the award in writing and the insurance company has to be informed of it within 30 days and
  • The Insurance company has to comply with the award in 15 days after that.

For any further query related to your insurance claims or other grievances please write to us in the comment box below or directly on CONTACT US Page. We assure you that we will try our best to provide you with a most feasible solution.

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