Page 83 - Insurance Surveyors Book Ebook IC S01

Survey And Loss Assessment IC-S01

Insurance company has to compulsorily accept the judgement of ombudsman

and do not have recourse in higher courts.

Suggested amendments by law commission

Final recommendation of law commission in regard to grievance Redressal

mechanism (GRA) is as follows:-

a. Adjudicating officers/investigation officers appointed by IRDA shall investigate

into violation with the act rules and regulation and levy penalties as provided in

the act. The aggrieved person can appeal to Insurance Appeallate Tribunal if not

satisfied.

b. Every insurance company will set up an In-House Grievance Redressal

mechanism under the overall supervision of IRDA. The insured must first

approach the insurance company. If insured is not satisfied or no decision is

given within a period of 60 days then he can approach GRA within a period of 60

days from the date of receipt of decision from insurers.

c. GRA will replace the present system of ombudsman. GRA will be statutory

authority exercising statutory function. It will not exercise any jurisdiction in

relation to the levy fines and penalties in relation to offences under the act.

d. The jurisdiction of GRA will be to hear

i) dispute between insured an insurer pertaining to partial or total

repudiation of claim, premium, legal construction of policies, delay in

settlement of claims, nonissuance of a document, any other complaint

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