Insurance products, be it life, health or motor-related can be somewhat difficult to understand in terms of coverage, exclusions and other aspects such as sub-limits, co-payments and no claim bonus. While the awareness about insurance products is slowly improving, it is still low compared to the same in developed nations. This leaves room for misrepresentation, mis-selling and sometimes even fraud.

For instance, recently some “policyholders” of Bajaj Allianz General Insurance company tried to make a claim on their motor insurance policy. But the insurer didn’t settle their claims as the policies held by them were fake. Though the insurance company claims to have taken the necessary steps against the fraudsters, it was the “policyholders” who were left in the lurch. While these individuals will have to fight it out in court, others who hold a genuine policy have recourse in case of any issues.

So, if you are an aggrieved policyholder, here is how you can file a complaint.

First step

If you have any issue or a complaint against an insurer, the first step is to inform the respective insurance company’s grievance redressal cell. All life and general insurance companies provide details contact personnel (phone number and email address) on their website and the policy document. You can reach out to insurers through their digital platforms as well. With offices/branches of insurers temporarily were closed or working at minimum capacity, post pandemic , insurance companies have taken initiatives to encourage policyholders to access their services through digital touch points such as WhatsApp, mobile apps, chatbots and e-mails.

Alternatively, you can directly connect with the insurer and raise a complaint by calling the toll-free number provided on the website and in the policy document.

Insurers update you on the status of the complaint through SMS or email.

Time limit

The insurer should acknowledge the complaint within three days and provide a solution within 15 days or as per the time limit set by the insurance regulator, IRDAI. The regulator has defined the maximum turnaround time (TAT: time taken for completing a task or process) for different services provided by the insurers. For instance, the maximum TAT for life insurers when it comes to settlement of maturity claim or survival benefit or penal interest not paid is 15 days. Similarly, TAT is 30 days for settlement of death claims without investigation requirements and is six months in cases with investigation. You can get the details on TAT from the websites of the respective insurers or IRDAI.

A few insurers such as Digit Insurance provide detailed TAT for each of their services. For premium-related issues, the maximum TAT is 10 days. These issues include premium paid but the receipt not received by the policyholder or premium charged wrongly by the insurer.

If your issue is unresolved at these levels, you can write to the grievance redressal officer of the respective insurer. Again, the contact details (email/phone) will be available in your policy document and on the insurer’s website.

Escalation

If your complaint is still not addressed within the time limit or you are not satisfied with the resolution offered, you can contact IRDAI directly. You can register your complaint in one of the three ways.

First, call the toll free number (details available on the IRDAI website as well on the insurers’ websites). Two, send an e-mail along with the resolution offered by the insurer, if any, along with your policy document or policy number and other relevant supporting documents, if any. Three, you can register your complaint online and keep track of it using Integrated Grievance Management System (IGMS). Alternatively, you can write to the regulator’s grievance cell along with the requisite documents. For this, you need to fill the complaint registration form (available online on IRDAI’s website) and post the same to the Consumer Affairs Department- Grievance Redressal Cell, IRDAI.

Beyond this, you have the right to lodge your complaint with the insurance ombudsman or a consumer/civil court. The details of the insurance ombudsman are available on the respective insurers’ websites and your policy document. You can approach the office nearest to you.

If both parties agree for mediation, the ombudsman gives a recommendation within one month from the date of complaint. Otherwise, the ombudsman passes judgement within three months from the date of receipt of all requirements from the complainant. Keep in mind that you must approach the ombudsman within a month from the date of sending a written complaint to the insurer (to which there is no reply) or within one year from rejection by the insurer.

However, before you escalate the matter with IRDAI or the ombudsman, you must first write to your insurer.

Do note that, you don’t have to pay a fee for making a complaint.

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