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Denial of claim is not the end of the road
25-Apr-2021
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It can be very dispiriting to have an insurance claim rejected. It hurts financially and your peace of mind and trust fade.

Claims rejection, delays in settling claims and lack of proper communication with the policyholder are stories we have heard or experienced.

Being treated unfairly is disconcerting, especially because you have paid for a promise.

Preserving documents

Documentation is the most important thing in insurance, whether it is buying a policy or making a claim.

So, preserve all relevant documents and all communication which you should ensure is in written form.

Before we discuss the documentation and process for filing various claims, let us see what recourse you have if your claim is rejected or if, in your opinion, it is handled poorly.

After you file a claim and provide the company with all the documents it asks for, they should accept or reject the claim in two weeks.

If this turnaround time is not adhered to, you can complain to the grievances officer of the branch in which your policy is. In writing of course, quoting the details of the policy and the claim.

This can be by hard copy letter, email or other electronic means of written communication. Please get an acknowledgement for any communication you send.

You can also complain if you do get a response but you are not happy with it. Of course, you can complain if your claim is rejected.

Every insurer has to have a policy for policyholder service parameters approved by its board of directors as mandated by the Insurance Regulatory and Development Authority of India (IRDAI).

The policy should specify turnaround times for various services to policyholders and an ‘effective grievance redressal mechanism” to ensure that complaints are resolved in a time-bound and efficient manner.

Complaints to the grievance officer can be about dissatisfaction with the insurer, distribution channels, intermediaries, insurance intermediaries or other regulated entities about an action or lack of action about the standard of service or deficiency of service and the insurance company is required to resolve a grievance within two weeks of its receipt.

If it is not resolved, or resolved to your satisfaction, you can escalate your complaint to IRDAI which will take it up with the insurance company and facilitate a re-examination of the complaint and resolution.

You can call the IRDAI Grievance Call Centre on toll-free numbers 155255/1800 425 4732.

It works from 8 a.m. to 8 p.m., Monday to Saturday and offers services in English and all major Indian languages.

You can send an e-mail to complaints@irda.gov.in

You can also visit IRDAI’s consumer education website www.policyholder.gov.in and fill and submit the complaint registration form there.

And then, there is the good old postal method. Just send your complaint letter with copies of all the supporting documents by post or courier to The General Manager, Consumer Affairs Department - Grievance Redressal Cell, Insurance Regulatory and Development Authority of India (IRDAI), 4th Floor, Survey No. 115/1, Financial District, Nanakramguda, Gachibowli, Hyderabad – 500032.

Online complaint system

IRDAI has also established an online complaints registering system called the Integrated Grievance Management System (IGMS) at www.igms.irda.gov.in where you can fill and submit a form with your complaint. Unveiled in 2011, IGMS is structured so your complaint reaches both the regulator and your insurance company.

The IRDAI is monitoring your complaint and your insurer knows this!

You can track the status of your complaint as the actions taken by your insurer are updated on the system which alerts the various stakeholders on tasks and deadlines.

Your complaint should be resolved in two weeks and, if you don’t revert in eight weeks after that, the complaint will be closed by the insurance company.

If the company does not respond even after 15 days or if you are not satisfied with the action taken, you can escalate the complaint to IRDAI again and the regulator will take it up with the company for resolution.

You still can go to the Insurance Ombudsman or seek other legal remedies if the insurance company’s response is not to your satisfaction. And we will see more about that too.

Source : The Hindu back
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