Those who are customers can take recourse to the insurance ombudsman whenever their grievances are not taken care of by the insurance companies in spite of getting complaints escalated directly to the senior management. The orders passed by the insurance ombudsman will remain binding on insurance companies. However, there may be situations where the orders are accepted by these companies and yet they keep delaying the action to be taken or simply fail on the same altogether.
As per a circular issued by the IRDAI (Insurance Regulatory and Development Authority of India), several insurance companies did not adhere to the verdict issued by the insurance ombudsman within a period of 30 days of receiving their directives and no appeals were filed within 60 days as well. This was for the duration between April and December last year. There were only a few insurance companies that complied with the directives within the given timeline.
Not complying with the requisite timeline can lead to a breakdown of the entire framework for redressal of grievances. IRDAI has also taken insurance companies to task for not giving proper reasons for delays along with giving a warning for not complying with award based directives within the specified timeline.
Customers should have a clear understanding of their own rights and the other regulations that come into play in case the ombudsman awards are not suitably executed. In case you have already been facing this problem, you will have to be a little patient. The ombudsman awards are binding on insurance companies and they eventually have to comply no matter how long they might delay the process. IRDAI and the insurance ombudsman will both follow up with the companies in this period so you can keep reaching out to these agencies for resolution.
The maximum award can be Rs. 30 lakh inclusive of your costs. The office has to finalize these aspects and pass the award within 3 months of getting documents from the policy holder and other procedures. A verdict copy has to be dispatched to the insurer and policy holder. The former has to adhere to the order within 30 days and inform the ombudsman accordingly.
Here are your options:
· The grievance redressal officer of the insurance company- contact details may be available on the website of the company.
· The complaint may be escalated in case of no responses via the integrated grievance management system from IRDAI-igms.irda.gov.in.
· You can also visit the insurance ombudsman’s office which has jurisdiction over your case.
· In case the verdict does not seem rightful to you, the consumer courts may be approached likewise.