How to Complaint against the Insurance Company
Problems with an insurance company with respect to delays in claim settlements, disputes over premium, misrepresentation of policy’s terms and conditions are commonplace. These issues can be resolved by making a complaint to the Grievance Redressal Officer of the respective branch. In such cases, the insurance company is liable to respond within 15 days of the receipt of the complaint.
According to the Insurance Regulatory and Development Authority (IRDAI) guidelines, your selected insurance company should ideally address and solve your concerns and issues within a time span of 15 days. However, if your protestation is not resolved within 15 days, or if you are not content with the decision taken, you can further develop the issue to the next level.
In case the insurance company delays or fails to address the complaint within the specified period of time or gives an up-to-par solution, then the complainant can also register their dissent with the Grievance Redressal Cell of the Consumer Affairs Department of IRDAI. Here are some ways through which you can register the complaint against your insurance company:
6 Ways to register your complaint against an insurance company in India
Complain to the insurer: In case of any issue with the insurance policy, a policyholder should first approach the insurance company for the redressal of the grievance. You can reach the grievance redressal officer (GRO) of the insurance provider. To do that, you can either visit the closest branch or send an email to the GRO. All insurance companies have their set of rules to manage consumer complaints with all the relevant details like whom to get in touch with and how to further escalate the issue.
Waiting for resolutions: As per IRDAI guidelines, the insurance company should ideally address your concerns and issues within 15 days. However, suppose it does not get resolved within 15 days, or if you are not satisfied with the resolution provided by the insurer. In that case, you can further register your complaint with the insurance regulator, IRDAI.
Escalating to IRDAI: You can reach the Grievance Redressal Cell of the Consumer Affairs Department of IRDAI by calling their Toll Free Number 155255 (or) 1800 4254 732 or by sending an e-mail to firstname.lastname@example.org. You can also use their online portal managed by the IRDAI called Integrated Grievance Management System (IGMS).
After receiving the complaint, a token number is generated and given to the complainant. It is then forwarded to the insurance company for revisory and returned within two weeks. If the revised response is inadequate, the complaint is escalated to the insurance ombudsman, consumer forum, or civil court.
If the insurer does not fully attend to the complaint within 15 days, you may use the IGMS to escalate the objection to IRDAI.
Send a letter to IRDAI: If you are not able to use the online methods, you can attempt an offline route. The policyholder can download the complaint registration form available on the IRDAI website. Fill in the form and send it to the General Manager, Consumer Affairs Department, Grievance Redressal Cell, IRDAI with the relevant documents.
Insurance Ombudsman: If you are still not satisfied with the solution, you can approach the appellate authority or the Insurance Ombudsman. The government created the Insurance Ombudsman project to enable individual policyholders to have their complaints settled out of court systems in a cost-effective, efficient, and impartial way.
However, there are certain conditions to adhere to before approaching the Insurance ombudsman. Your complaint should be related to the policy that you took in your individual capacity, and the value of the claim should not be above Rs 30 lakh.
The Ombudsman acts as a mediator and will arrive at a fair recommendation based on the facts of the dispute. If you accept their recommendation as a full and final settlement, the Ombudsman will inform the company to comply with the terms in 15 days.
However, suppose a settlement via recommendation does not work. In that case, the Ombudsman shall pass an award within 3 months of receiving all the essential requirements from the claimant, which will be binding on the insurance company. Once the award is passed, the insurance company shall comply with the award within 30 days of the receipt of the award and intimate the compliance of the same to the Ombudsman.
File a complaint in a consumer forum or a civil court
If, after following all the above ways, your grievances are still left unresolved, and you feel that your claim is legitimate regardless, then you have the option to approach a consumer forum or a civil court.