Disputes do arises under the insurance policies either due to repudiation of claims or payment of claim amount not as per the claim bill filed. To resolve these issues, many options are available to the policyholders as under:
- Complaint may be filed with the Insurer
- Integrated Grievance management System (IGMS)
- File a Complaint with Ombudsman
- File a legal case under Consumer protection Act 1986
1 . Complaint may be filed with the Insurer:
- Approach the Grievance Redressal Officer of its branch or any other office that you deal with.
- 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 Send an e-mail to firstname.lastname@example.org
2. Integrated Grievance management System (IGMS)
Make use of the Integrated Grievance Management System
- Register and monitor your complaint at https://igms.irda.gov.in/ or compliant form may also be to IRDAI at Hyderabad
- TAT for resolving the complaints is 3 days to 6 months in life insurance and 3 days to 30 days in General Insurance.
3. File a Complaint with Ombudsman
Any individual (not any business entity) and claim amount not exceeding Rs 30 lakhs including interest may file a complaint in the prescribed form an Insurance Ombudsman in the respective State of the Policyholder. The decision of the Insurance Ombudsman is binding on the Insurer while the Policyholder has the option to file a complaint under Consumer Protection Act 1986. There is no fee to file a complaint application. The time limit of decision is 30 days from the date of filing the complaint. The legal Advisor is not permitted to present at the time of hearing.
4. File a legal case under Consumer protection Act 1986:
Any Individual or Business Entity can file a complaint with the following consumer courts:
- District Forum if the premium amount ,in particular policy, is not more than Rs 100 lakhs
- State Commission if the premium amount, in particular policy, is more than 100 lakhs but nor more than 1000 lakhs
- National Commission, if the premium amount , in particular policy, is more than Rs 1000 lakhs.
- Though there is no Stamp duty to file a complaint but nominal amount of Court fees is to be deposited while filing a complaint.
The appeal can be filed with the State Commission for the decision of the District forum and National Commission for the decision of the State Commission. The appeal against the decision of the National Commission lies with the Hon’ble Supreme Court.