Page 56 - Insurance Times February 2021

According to the circular, "...an online platform has to be can file a complaint.
developed by the Council for Insurance Ombudsmen for If you have any issue or a complaint against an insurer, the
online submission and tracking of the status of complaints first step is to inform the respective insurance company's
lodged with any office of Ombudsman." grievance redressal cell. All life and general insurance
Chandan D. S. Dang, executive director,SecureNow.in, said companies provide contact details (phone number and email
the draft rules specify insured-friendly changes such as address) on their website and the policy document.
providing an online management system for submission and You can reach out to insurers through their digital touch
tracking of complaints to Ombudsmen. points such as WhatsApp, mobile apps, chatbots and e-mails.
Dang added that, "As per the new notification, the Alternatively, you can directly connect with the insurer and
Ombudsman may, on his own or the request of the raise a complaint by calling the toll-free number provided
complainant, hear a matter through video conference if he on the website and in the policy document.
is satisfied that circumstances so require, after notifying the The insurer should acknowledge the complaint within three
complainant and the insurer concerned, subject to days and provide a solution within 15 days or as per the
guidelines issued by the Council for Insurance Ombudsmen time limit set by the insurance regulator, IRDAI. The
in this regard and published on its website." regulator has defined the maximum turnaround time (TAT:
An insurance ombudsman is created for individual time taken for completing a task or process) for different
policyholders to have their complaints settled out of the services provided by the insurers. For instance, the
court's system in a cost-effective, efficient and impartial maximum TAT for life insurers when it comes to settlement
way. of maturity claim or survival benefit is 15 days.
Currently, as per policyholder.gov.in website, there are 17 If your issue is unresolved, you can write to the grievance
insurance ombudsman in different locations and any person redressal officer of the respective insurer. The contact
who has a grievance against an insurer, may himself or details available in your policy document and on the insurer's
through his legal heirs or nominee, can make a complaint website.
in writing to an insurance ombudsman within whose If your complaint is still not addressed within the time limit
jurisdiction the branch or office of the insurer complained or you are not satisfied with the resolution offered, you can
against or the residential address or place of residence of contact IRDAI directly. You can register your complaint in
the complainant is located. one of the three ways.

Ways to redress grievances First, call the toll free number (available on the IRDAI
Insurance products, be it life, health or motor-related can website/insurers' websites). Two, send an e-mail along with
be somewhat difficult to understand in terms of coverage, the resolution offered by the insurer, if any, and your policy
exclusions and other aspects such as sub-limits, co-payments document and other relevant documents, if any. Three, you
can register your complaint online using Integrated
and no claim bonus. The awareness about insurance
products is still low compared to developed nations. This Grievance Management System.
leaves room for misrepresentation, misselling and Alternatively, you can write to the regulator's grievance cell
sometimes even fraud. with the requisite documents. For this, you need to fill the
complaint registration form (IRDAI's website) and post the
For instance, recently some "policyholders" of Bajaj Allianz same to the Consumer Affairs Department- Grievance
General Insurance tried to make a claim on their motor
insurance policy. But the insurer didn't settle their claims Redressal Cell, IRDAI.
as the policies held by policyholders were fake. Though this Beyond this, you have the right to lodge your complaint
insurer said to have taken the necessary steps against the with the insurance ombudsman or a consumer/civil court.
fraudsters, it was the "policyholders" who were left in the The details of the same available on the respective insurers'
lurch. While these individuals will have to fight it out in websites.
court, others who hold a genuine policy have recourse in However, before you escalate the matter with IRDAI or the
case of any issues. ombudsman, you must first write to your insurer. Do note
So, if you are an aggrieved policyholder, here is how you that, you don't have to pay a fee for making a complaint.

The Insurance Times, February 2021