Sunday, 24 July 2016

Where (How) to File Complaint against Insurance Company in India


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If you have filed an insurance claim and it’s been rejected by your insurance company and you think it’s unfair, then there are many ways to file a complaint against the insurer. Generally, no insurance company rejects a claim request unreasonably; there are many reasons due to which an insurer may refuse to honor a policy claim. However, if you think that it’s unfair and you have supporting documents (like: policy wording, premium receipts etc) to prove that your claim should be honored then don’t embarrass, there are some authorities setup by the government to help you.
Complaint against Insurance Company India
In India IRDAI (Insurance Regulatory and Development Authority of India) regulates insurance industry. IRDAI makes stringent rules and regulations for insurance companies to protect the interests of the policyholders. To curb misselling and unfair claim denials, the authority has setup many guidelines for the insurers and it regularly checks that whether insurers are following its guidelines or not.

You can file a complaint against your insurance company if;

  • The insurer has rejected your claim request
  • The insurer is delaying in claim settlement
  • You’re not satisfied by the claim settlement
  • The insurance company is not complying with policy terms etc.
Filing a complaint against an insurance company is very easy but you have to follow a predefined procedure to do so for instance; you have to approach the grievance redressal officer first before approaching other authorities.

Procedure to file a complaint against the insurer

  1. Approach The Grievance Redressal Officer of concerned insurance company (Mandatory)
  2. Lodge your complaint with Integrated Grievance Management System (Optional)
  3. Lodge a complaint with Ombudsman 
  4. Lodge a complaint with Consumer Court or Civil Court 
Important: Usually, complainant doesn’t need a lawyer to register a claim dispute; however, if you think that you’re unable to explain your side then you may hire a lawyer to represent your case. It is not advised to hire a professional because you’re not going to get any compensation for that and you have to pay the attorney’s fee from your own pocket. Personally, I don’t think that you need anyone’s help to file a complaint because all you have to do just send your complaint to the concerned grievance redressal agency in writing (signed by insured person) with supporting documents and leave everything else on the authorities. They (authorities) will analyze your case and try to settle your dispute with mutual settlement.

Approach the Grievance Redressal Officer

As per Insurance Regulatory and Development Authority of India (IRDAI) guidelines, all insurance companies required to have a responsive grievance redressal officer to handle policy related disputes. Incase your claim has been dishonored by the insurer then you have to approach the grievance redressal officer.

Procedure:

  • Give your complaint to the officer in writing along with the supporting documents. For contact details of Grievance Redressal Officer of your insurance company visit IRDAI official website, or visit your insurer website, or contact to your insurance customer service department, or visit nearest office of your insurer, or read your policy documents. 
  • Don’t forget to collect acknowledgement receipt with the date. You may need it in future.
  • After receiving complaint, your insurance company should deal with your complaint within 15 days; therefore, wait for that.
  • If your insurer fails to respond within the time limit or you are unhappy with the settlement or response then proceed to the next option described below. 

Lodge your complaint with Integrated Grievance Management System (Optional)

You can register your complaint online with IGMS to get quick response from your insurer. You can register your complaint on IGMS if your insurer does not attend your complaint within the specified time (15 days). If you already have received a response from your insurer then it would be unworthy to register a complaint on this forum.

Procedure:

  • Visit http://igms.irda.gov.in/ and register yourself by entering the required details.
  • After registration, login and register a complaint
  • You may also track status of your complaint 
Please Note: Only cases of delay and non-response are taken up by the IGMS. It only helps to get a quick response from the insurance company. Insured can approach judicial channels i.e. Ombudsman, consumer court, or civil court for other matters.

Lodge a complaint with the Insurance Ombudsman

In 1998, the government of India made Redressal of Public Grievance Rules, 1998 under The Insurance Act 1938 to resolve disputes relating to claim settlements. It introduced an efficient and cost effective way to resolve issues relating to claims. Policyholders who could not get their complaints redressed by insurers may approach the ombudsman relevant to their states. After receiving and analyzing a complaint, the ombudsman acts as a mediator between the insured person and insurer and tries to resolve the issue with mutual consent.

Important Points:

  • It is mandatory to approach the grievance redressal officer of the insurer before filing complaint with the ombudsman. Complaint can be filed if you’re unsatisfied with the reply by the insurer.
  • The ombudsman may reject your complaint if he thinks that your objection is unreasonable.
  • The ombudsman should pass recommendation within one month of the receipt.
  • If the ombudsman fails to reach on a mutual settlement then he can pass a necessary award if he thinks so. The decision to accept or reject the award is up to the policyholder but the insurance company is bound to comply with the decision.
  • If the policyholder accepts the award offered by the ombudsman then he/she (policy-owner) has to send written intimation to the ombudsman. 
  • You don’t need a lawyer to lodge a complaint with the insurance ombudsman. 
  • Complaint cannot be registered after one year from the date of rejection of claim.
  • If your complaint is pending in consumer court or any court of law then wait for the verdict before going to the insurance ombudsman or vice versa.

Procedure:

  • Contact details of the ombudsman can be obtained from the official website of IRDAI or you may visit your insurer’s branch/website for the same.
  • Submit your complaint in writing to the concerned ombudsman along with the documents supporting your allegations. 
  • The grievance can be sent by post. 

Lodge a Complaint with Consumer Court or Civil Court

Insurance grievance redressal issue can be brought to civil courts or consumer forums. If your insurer refusing/delaying claim settlement then you can seek help from consumer court or civil court.

Important Points:

  • If your complaint is pending with the insurance ombudsman then wait for the solution offered by him before going to the consumer or civil court. 
  • If claim amount is RS 20 Lakhs or Less then case can be filed in District Consumer Disputes Redressal Forum
  • State Consumer Disputes Redressal Forum can hear the cases involving the amount more than RS 20 Lakhs and less than RS 1 crore.
  • National Consumer Disputes Redressal Forum can deal with the cases where the value of the goods or services or compensation is more than RS 1 crore. 

Procedure:

  • Write your complaint stating all the facts and clearly mention what compensation or relief you are seeking. 
  • Submit your complaint to concerned consumer forum under whose jurisdiction your case falls (read important points above). 
Note: Visit official website of consumer forum to know how to register a complaint with consumer forum.
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