When purchasing life insurance, general insurance, or health insurance, people frequently depend on recommendations from friends, family, coworkers, or an insurance company representative. This might lead to total dissatisfaction with the services. Even insurance purchased after extensive study may occasionally fail you. You may be dissatisfied with a certain Life Insurance, General Insurance, or Health Insurance company for a variety of reasons and desire to submit a complaint with the insurance company.
There are several grounds for complaints against life insurance companies.
- Claim for Death
- Medical Insurance Claims (Including Critical Illness)
- Arguments for Survival
- Policy Servicing Proposals are being processed.
- Injustice in Business and ULIP
The processes to submit a complaint against an insurance company are as follows.
- Speak with the insurance provider
Before going somewhere else, it is preferable to make a complaint with the insurance company right away. If the insurance provider’s branch office or customer service division is unable to handle your problem satisfactorily, you may file a written complaint with the insurance company’s Grievance Redressal Officer (GRO). You can make a complaint with the insurance company by doing the following:
- Delivering a letter properly signed by you (the policyholder) to the branch’s GRO in person at the insurer’s local branch, or sending an email to the GRO using the email address linked with your registered email account.
The official email address of the GRO may be found on the insurance company’s website. It is advised that you send your complaint and any supporting documentation together to save time.
To track the complaint or use it as a reference in the future, make sure you receive an acknowledgement through letter or email (depending on the communication method you choose) within a reasonable amount of time. The complaint number, policy number, and contact information for the Grievance Redressal Officer who will address the case are all included in the acknowledgment. Each insurance company has its own complaint processing policy, which is published on the firm’s website. A list of all the insurers’ complaint processes is also available here. The insurance company has 15 days from the moment the complaint is received to resolve it. If you don’t hear back, you can escalate the situation.
- The IRDAI’s Grievance Redressal Cell
The IRDAI’s Consumer Affairs Department’s Grievance Redressal Cell takes up the complaints with the appropriate insurers for resolution. If the insurance provider’s GRO does not respond or does so in an undesirable manner, you can contact the IRDAI’s Grievance Redressal Cell.
The IRDAI’s Grievance Redressal Cell accepts grievances via:
- Using the IRDAI Portal’s Integrated Grievance Management System (IGMS), which may be found at https://www.igms.irda.gov.in. The most recent status is available online, and you may use this site to make a complaint against an insurance provider.
- Sending an email to email@example.com or calling the toll-free numbers 155255 or 1800 4254 732
- Submitting a paper application to the IRDAI at the following addresses:
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 grievances lodged by claimants or insureds. Attorney, agent, or other third-party complaints filed on behalf of the policyholder are not considered.
The Grievance Redressal Cell will be unable to process your complaint unless you provide the requested information in the form.
The Turn Around Time (TAT), which varies depending on the complaint, will be indicated in the acknowledgement. Nonetheless, if you are happy with the Grievance Redressal Cell’s response or solution, you are free to take your complaint further.
- The Insurance Ombudsman
If you do not receive a satisfactory response from your insurance carrier or the IRDAI’s Grievance Redressal Cell, you can contact the Insurance Ombudsman. The Insurance Ombudsman scheme was developed by the Government of India to allow individual policyholders to handle their issues fairly and profitably outside of the court system.
There are presently 17 Insurance Ombudsman around the country. The Insurance Ombudsman receives written complaints from policyholders against insurance firms, whose geographical jurisdiction includes the insurer’s branch or office that is the subject of the complaint, as well as the complainant’s personal address or place of habitation.
In contrast to the Grievance Redressal Cell, a policyholder’s legal heirs, nominees, or appointees may make a complaint on their behalf.
A grievance may be filed with the Insurance Ombudsman.
- Your insurance company has denied your claim.
- You were dissatisfied with how the insurance company handled the situation.
- After 30 days, the insurance company has not reacted to your complaint.
- Your complaint is about any policy that you adopted in your own capacity.
- The total cost of the claim, including all expenses, is not more than Rs 30 lakhs.
Your complaint to the Insurance Ombudsman about insurance might be about:
- Delay in processing claims after the cutoff date set in the IRDAI Act of 1999 regulations.
- Any refusal of a claim by a life, general, or health insurance company, in whole or in part.
- Any disagreement over the premium owed or paid under the terms of an insurance policy.
- Any misrepresentation of the policy’s terms and conditions in the agreement or policy document.
- The dispute about the claim and the legal interpretation of insurance contracts.
- Complaints concerning insurance policy service filed against insurers, their agents, and intermediaries.
- Complaints concerning insurance policy service filed against insurers, their agents, and intermediaries.The proposer’s proposal form does not authorise the issuing of life insurance, general insurance, or health insurance policies.
- After receiving a premium for life insurance, general insurance, and health insurance, the insurance policy is not issued.
- Any additional matter resulting from a violation of the Insurance Act of 1938, any regulations, circulars, guidelines, or instructions published by the IRDAI from time to time, or the terms and conditions of the insurance contract, insofar as it relates to the items mentioned in sections “a” through “f.”
Settlement of Disputes by the Insurance Ombudsman:
The ombudsman chooses between two methods of resolution: resolution by award and resolution by suggestion.
- Settlement by Recommendation: The Insurance Ombudsman settles disputes by acting as a mediator and issuing an appropriate recommendation, depending on the specifics of the conflict.
- If you (the policyholder) accept it as a complete and final settlement, the Insurance Ombudsman will notify the insurance company, and they will have 15 days to abide by the conditions.
- Settlement by Award: After obtaining all the information from the complaint and three months, if you reject the advice, the Insurance Ombudsman will render a binding judgment on the insurance company.
- The insurance company is required to abide by the award after it has been authorized and must inform the Insurance Ombudsman of their compliance within 30 days of receiving it.
- A consumer forum or civil court
You can get in touch with the Consumer Court if the issue is still not resolved. A specific branch of the Consumer Court handles disputes relating to life insurance and general insurance (including Health Insurance).
The specialists at RESO are just a click away if you ever run into a difficulty involving any type of insurance. They can assist you in submitting an online insurance company complaint.