We can often here about dispute between insurence company, and their customers. The complainant is not new that a consumer not receive their claims money in the right time. In such cases, their is a way to register your complaint. We’ll talk about that in this article.
The Insurance Ombudsman is an independent body that resolves disputes between insurance customers and insurance companies. Its objective is to ensure that customers receive speedy and fair resolution without the need for court proceedings. You can approach the Insurance Ombudsman only if your complaint is up to ₹50 lakh. If your claim amount is higher than this, you will need to resort to a court or consumer forum. Importantly, you must first file a complaint with your insurance company and give them 30 days to respond.
If the company doesn’t respond or you’re not satisfied with the response, you can approach the Insurance Ombudsman within one year from the date of the claim rejection. However, complaints will not be accepted after one year. According to Anita Teli, Chief Compliance Officer at Probus Insurance, before approaching the Insurance Ombudsman, a customer should file a formal complaint with the insurance company themselves. If the issue isn’t resolved within a month, they can approach the Ombudsman. The Insurance Ombudsman aims to resolve complaints within 60 to 90 days. If both parties (customer and insurance company) agree to mediation, the matter can be resolved within 30 days.
These documents are necessary:
- Complaint letter sent to the insurance company or broker
- KYC documents (Aadhaar, PAN, Driving License etc.)
- Insurance company’s response or rejection letter
- Copy of insurance policy
- All medical records or evidence related to the claim
- Passport size photo when filing an online complaint
In what cases can you complain?
- Undue delay in claim settlement (more than 15 days)
- Full or partial rejection of the claim by the insurance company
- Dispute regarding premium amount
- Incorrect information or misinterpretation of the insurance policy
- Policy servicing complaints (negligence by agents or brokers)
- Non-issuance of policy as per the insurance proposal
- Non-issuance of policy even after premium is paid
- Violation of IRDAI regulations or disregard for customer interests