complaint against insurance company

How Can You File a Complaint Against an Insurance Company?

Online Legal India LogoBy Online Legal India Published On 15 Sep 2022 Category Consumer Complaint

People frequently purchase Life Insurance, General Insurance, and Health Insurance plans only on the advice of their loved ones, co-workers, friends, or a representative of the insurance business. This might lead to utter unhappiness with the services. And occasionally, even insurance coverage you purchase after thorough study can disappoint you. You may not be happy with a specific Life Insurance, General Insurance, or Health Insurance company for various types of reasons, and you may want to lodge a complaint against insurance company.

Several reasons for grievances against a life insurance company

  • Death Claims
  • Health Claims (Including Critical Illness)
  • Survival Claims
  • Policy Servicing
  • Proposal Processing
  • Unfair Business Practices
  • ULIP Related

Some basic reasons for complaints about a health insurance provider:

  • Claims
  • Cover Note
  • Coverage
  • Premium
  • Policy Related
  • Proposal Processing
  • Product or Sales Related
  • Refund

Following are the steps to file a complaint against insurance company
 

1. Approach the Insurance Company
 

It is best to register a complaint with the insurance company directly before going somewhere else. You can approach the insurance company's Grievance Redressal Officer (GRO) with a written complaint if you do not receive a satisfactory solution to your issue from the branch office or customer care division of the insurance provider. You can contact the insurance company with a complaint by:

  1. Visiting the insurer's closest branch and delivering a letter that is properly signed by you (the policyholder) to the branch's GRO, or
  2. Send an email to the GRO's official email address using your registered email account.

On the official website of the insurance company, you may find the GRO's official email address. It is advised to send all supporting documentation with your complaint itself in order to save time.

Make sure you receive the acknowledgement through letter or email (depending on the communication method you selected) within a reasonable amount of time so that you may use it to track the complaint or for future reference. The complaint number, policy number, and contact information for the Grievance Redressal Officer who will handle the issue are all included in the acknowledgement.

Each insurance company has a unique grievance redressal policy, which is available on its website of the insurance company. Here you may also find a list of all the insurers' policies for handling complaints.

The complaint must be resolved by the insurance provider within 15 days of receiving it. You can escalate the problem to the next level if you don't get a response or the remedy is unsatisfactory.

2. Grievance Redressal Cell of the IRDAI
 

The IRDAI's Consumer Affairs Department's Grievance Redressal Cell takes up the complaints with the appropriate insurers for resolution. You can contact the IRDAI's Grievance Redressal Cell if the GRO of the insurance carrier does not respond or does so in an unsatisfactory manner.

You can file a grievance with the IRDAI's Grievance Redressal Cell by:

  1. Submitting a complaint using the IRDAI Portal's Integrated Grievance Management System (IGMS) at https://www.igms.irda.gov.in. This site can be used to register a complaint against insurance company, and the most recent status can be found online.
  2. Sending an email to the complaints@irdai.gov.in email address.
  3. Dialling either 155255 or 1800 4254 732, two toll-free numbers.
  4. Sending a paper form to the IRDAI with the following addresses:

General Manager,

The Insurance Regulatory and Development Authority of India (IRDAI)

Consumer Affairs Department - Grievance Redressal Cell.

Sy. No. 115/1, Financial District, Nanakramguda,

Gachibowli, Hyderabad - 500 032.

The Grievance Redressal Cell responds to complaints submitted by claimants or insureds. On behalf of the policyholder, complaints submitted by attorneys, agents, or any other third party are not taken into consideration.

The Complaint Registration Form can be downloaded by clicking here. Without the necessary details requested in the form, the Grievance Redressal Cell will be unable to move forward with the resolution of your complaint.

The acknowledgement will inform you of the Turn Around Time (TAT), which varies for each complaint. You can take your problem to the next level, nevertheless, if you are not unhappy with the Grievance Redressal Cell's response or resolution.

3. Insurance Ombudsman
 

You can contact the Insurance Ombudsman if you receive an unsatisfactory response from the insurance company or the IRDAI's Grievance Redressal Cell. For individual policyholders to resolve their grievances outside of the judicial system in a financially advantageous, time-saving, and unbiased manner, the Government of India implemented the Insurance Ombudsman scheme.

There are now 17 Insurance Ombudsmen spread across the nation. Any policyholder who has a complaint against insurance company may submit it in writing to the Insurance Ombudsman whose territorial jurisdiction includes the branch or office of the insurer that has been the subject of the complaint, as well as the complainant's residential address or place of residence.

In contrast to the Grievance Redressal Cell, a policyholder's legal heirs, nominees, or appointments may make a complaint on their behalf.

A complaint may be made to the Insurance Ombudsman if:

  1. Your complaint has been denied by the insurance provider.
  2. You are not satisfied with how the insurance company handled the situation.
  3. After 30 days, the insurance provider has not at all reacted to your complaint.
  4. Any policy that you adopted while acting in your personal capacity is the subject of your complaint.
  5. The total amount of the claim, including all of the expenses, does not exceed Rs 30 Lakhs.

Your insurance-related grievance to the Insurance Ombudsman may be about:

  1. Delay in the resolution of claims past the deadline set forth in the regulations created by the IRDAI Act of 1999.
  2. Any rejection of claims, in whole or in part, by the life, general, or health insurer.
  3. Any disagreement regarding the premium owed or paid under the terms of an insurance policy.
  4. Any misrepresentation of the terms and circumstances of the policy in the contract or policy document.
  5. The legal interpretation of insurance contracts as they pertain to the dispute over the claim.
  6. Complaints involving policy servicing against insurers, their representatives, and middlemen.
  7. Life insurance policies, general insurance policies, and health insurance policies are not issued in accordance with the proposal form that the proposer has submitted.
  8. After receiving a premium for life insurance, general insurance, and health insurance, the insurance policy is not issued. 
  9. In so far as it relates to the matters stated in clauses "a" through "f," any additional matter arising from a breach of the Insurance Act of 1938, any rules, circulars, guidelines, or instructions published from time to time by the IRDAI, or the terms and conditions of the policy contract.

Dispute Resolution by the Insurance Ombudsman:
 

The ombudsman settles the complaints in two different ways: settlement by award and settlement by recommendation.

  1. Settlement by Recommendation: Based on the circumstances of the disagreement, the Insurance Ombudsman resolves disputes by serving as a mediator and making a fair recommendation.

The insurance company will be informed by the Insurance Ombudsman if you (the policyholder) accept it as a complete and final settlement, and they will have 15 days to abide by the terms.

  1. Settlement by Award: If you reject the advice, the Insurance Ombudsman will issue a binding decision on the insurance company three months after receiving all the necessary information from the complainant.

Once the award has been approved, the insurance provider must comply with it within 30 days of receiving it and notify the Insurance Ombudsman of their compliance.

4. Civil Court or Consumer Forum

 

If the complaint is still not settled, you can contact the Consumer Court. Life insurance and general insurance-related complaints are handled by a special division of the Consumer Court (including Health Insurance).

If you ever face any problem regarding any kind of insurance, the experts of Online Legal India are one click away from you. They will help you file a complaint against insurance company online.

 


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