Insurance Claim: How To File A Complaint Against An Insurance Company: Here Are 6 Ways

There can be various reasons why an insurance policy holder might want to file a complaint against an insurance company. Policyholders may wish to file a complaint related to the purchasing process, the claims process or requests for generic services such as change of address, contact details, appointments, offer of a certificate of savings. tax, changes in payment method, etc.

If you are someone who wants their grievance against an insurance company dealt with, here is an overview of the different ways to file a complaint.

Register your claim with the insurer

A policyholder must first approach the insurance company itself for their grievance to be dealt with. You can speak to the grievance officer (GRO) of the insurance company. You can either go to the nearest branch or send an email to the GRO. You can find the GRO email IDs for all insurance companies by clicking here.

When approaching the GRO, you must ensure that you lodge your complaint in writing with the necessary supporting documents. You should not forget to take a written acknowledgment of receipt of your complaint with the date.

Insurance companies have their own set of rules for handling customer complaints with all the relevant details, such as who to contact and how to escalate the issue. Click here to go through your insurer’s complaint handling process.

Wait for the insurer to solve the problem

According to IRDAI, the insurance company should ideally respond to your concern within 15 days. However, if your grievance is not resolved within 15 days, or if you are not satisfied with the resolution provided by the insurer, you can take the issue to the next level, i.e. you can submit it to the Insurance Regulator, Insurance Regulatory and Development Authority. of India (IRDAI).

Climb it at IRDAI

You can contact the IRDAI Consumer Affairs Department’s Grievance Unit by calling the toll-free number 155255 (or) 1800 4254 732 or by sending an email to [email protected] In addition to this, you also have the option of using the online portal managed by IRDA called Integrated Grievance Management System (IGMS). This is a way to escalate your grievance, so it should only be used after trying the insurance company’s grievance channel. If you cannot access the insurance company directly for some reason, IGMS provides a gateway to register complaints with insurance companies.

Use the IRDAI IGMS online portal

Many people are often faced with a situation where the branch of the insurer may be unwilling to accept and acknowledge the written complaint. Or, the policyholder may have a problem filing their complaint online on the insurer’s website. In such scenarios, it will be preferable to use the IGMS installation of IRDAI.

IGMS is a complete solution that not only provides centralized and online access for the insured, but also full access and control to IRDAI to monitor conduct issues in the market of which insureds grievances are the main indicators . IGMS classifies different types of complaints according to predefined rules. It assigns, stores and tracks unique complaint identifiers. It also sends information to various stakeholders as needed, in the workflow.

How to use IGMS

  • Visit the website
  • Register by entering your login details
  • Use saved credentials to record complaints / view status

It would be helpful to keep the policy document handy when registering the complaint online. You can make optimal use of this system by providing accurate information about the claim, such as policy number, insurer name, complainant contact details, etc.

A complaint registered via IGMS will be transmitted to the insurer’s system as well as to the IRDAI repository. The status update will be reflected in the IRDAI system. If the claim is not fully processed by the insurer within 15 days of filing, you can use the IGMS to send the claim to IRDAI.

Send a letter to IRDAI with your complaint

If you are unable to use the online methods, you can use the offline route. You can also download the IRDAI complaint form here and send your complaint by courier or by post to the following address:

General manager

Consumer Affairs – Grievance Resolution Unit,

Indian Insurance Regulatory and Development Authority (IRDAI),

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

Gachibowli, Hyderabad-500032

Raise the problem with the insurance mediator

If your complaint is still not dealt with to your satisfaction, you can contact the appeals authority or the insurance mediator. The insurance ombudsperson system was created by the government to ensure that individual policyholders have their complaints resolved outside the court system in a cost-effective, efficient and impartial manner.

There are currently 17 insurance ombudsmen in different parts of the country and anyone who has a grievance against an insurer can himself or through his legal heirs, agent or assigns, file a complaint in writing with the ombudsman. insurance in whose territorial jurisdiction the branch or office of the insurer complained of or if the residential address or place of residence of the complainant is located.

You must comply with certain conditions before contacting the insurance mediator. As the IRDA consumer education website, you must first contact your insurance company with the complaint. However, if they rejected it or did not resolve it to your satisfaction or did not respond to it at all for 30 days, then you can go to the insurance mediators. In addition, your claim must be related to a policy that you have taken out as an individual and the value of the claim, including the expenses claimed, does not exceed Rs 30 lakh.

How the Ombudsman Resolution Process Works

Settlement by recommendation: The ombudsman will act as a mediator and arrive at a fair recommendation based on the facts of the dispute. If you accept it as a full and final settlement, the Mediator will inform the company, which will have to comply with the conditions within 15 days.

Settlement by Award: If a settlement by recommendation does not work, the Mediator will issue an award within 3 months of receipt of all of the complainant’s requirements and which will be binding on the insurance company. Once the award has been rendered, the insurer must comply with the award within 30 days of receiving the award and notify the mediator.

File a case in a consumer forum or civil court

If your grievance is still not resolved after exhausting all other available options and you feel that your complaint is justified, you have the option of taking a consumer forum or civil court. For example, you can file a complaint with the Department of Consumer Affairs at the following link

Source link

Previous The IRS sends 430,000 refunds for unemployment tax compensation - who will receive about $ 1,189?
Next Nearly 45% of US policyholders consider changing their health insurance during open enrollment, according to survey