How to get insurance complaints resolved when companies don’t act

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It is vitally important for policyholders to read this blog, as we will discuss it at length how to resolve your grievances if the insurance company reject your complaints. Insurance ombudsman offices are a hope for the policyholders when their insurance complaints are not being registered by the insurers. The insurance ombudsman’s orders bind the insurers making them unable to escape. But what if the insurance companies accept the orders of the insurance ombudsman offices and delay in implementing them?

  • Violation of Faith: The policyholders might feel that they have been cheated by the insurance companies who fail to resolve their complaints but they should understand their rights and regulations they are authorized with in case of any false proposals of the ombudsman awards and trust that the regulators will take severe action as required. The regulators issue a warning and if needed it also picks up insurers to specify their reasons for the delay. They also take note of the transgressors and once it stated, “Non-compliance of awards by insurers within the timelines prescribed will be viewed very seriously. A circular from the Insurance Regulatory and Development Authority of India (IRDAI) notes, “Few insurers are submitting that they have complied with the award post timeline stipulated. Non-compliance within the timelines severely undermines the grievances redressal framework.”
  • Grievance Redressal: The policy holders who are having a tough time dealing with the insurance companies will have to be more patient in getting their complaints registered and their due sum of claims. Milind Kharat from the Insurance Ombudsman Mumbai office says, “The ombudsman awards are binding on insurers. There may be a delay, but they have no option to comply. IRDAI as well as insurance ombudsman offices monitor compliance closely and follow-up with insurers. An insurance ombudsman office can award at most Rs 30 lakh (inclusive of the costs incurred by the complainant) up from Rs 20 lakh aforementioned to revision rules. This sum can only be passed to the policy holder only after verification and within the three months of receiving the documents and other requirements. A copy of the verdict is sanctioned to both the policy holder and the insurer which requires to have complied with the order within 30 days and needs to inform the ombudsman.
  • The Grievance Redressal Mechanism: In order to lodge your grievance to the insurance company, all you have to do at first is find your insurer’s grievance officer’s contact details on its website. If you do not get any response or if their answers are not satisfactory, you can further heighten your complaint at IRDAI’s integrated grievance management system or you call directly approach the insurance ombudsman office under which your case remains. And even after addressing the ombudsman office, you are not satisfied then you could go beyond and approach the consumer courts.
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Ombudsman verdict has a stronghold on insurance companies and they are bound to comply with ombudsman awards. However, if the policyholder feels dissatisfied with their verdict then the best option to go for is the consumer courts. You can rely on consumer courts to file your complaint against insurance companies who do not resolve your needs, therefore it can be said that consumer courts are better to approach to get your complaints resolved f your insurers do not act accordingly.

Shailesh Kumar

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