There could be various reasons why an insurance policyholder might want to complain against an insurance company. Policyholders might want to raise a complaint related to the buying process, claim process or the generic service requests like changing address, contact details, nominations, offering tax saving certificate, payment method changes and so on.
If you are someone who wants to their grievance against an insurance company addressed, here is a look at various ways one can raise a complaint.
Register your complaint with the insurer
A policyholder should first approach the insurance company itself to get their grievance addressed. You can approach the grievance redressal officer (GRO) of the insurance company. You can either visit the nearest branch or send an email to the GRO. You can find the email IDs of GROs of all insurance companies by clicking here.
While approaching the GRO you need to make sure that you give your complaint in writing along with the necessary supporting documents. You should not forget to take a written acknowledgement of your complaint with the date.
Insurance companies have their own set of rules to manage customer complaints with all the relevant details like whom contact and how to escalate the issue. Click here to go through the complaint management process of your insurer.
Wait for insurer to resolve the issue
As per IRDAI the insurance company should ideally address your concern within 15 days. However, if your grievance is not resolved within 15 days, or if you are not satisfied with the resolution provided by the insurer you can escalate the issue to next level, i.e., you can take it to the insurance regulator, Insurance Regulatory and Development Authority of India (IRDAI).
Escalate it to IRDAI
You can approach the Grievance Redressal Cell of the Consumer Affairs Department of IRDAI by calling the Toll Free Number 155255 (or) 1800 4254 732 or by sending an e-mail to [email protected] Besides this you also have the option to use the online portal managed by IRDA called Integrated Grievance Management System (IGMS). This is a way of escalation of your grievance so it should only be used after you have tried the grievance redressal channel of the insurance company. If you are not able to access the insurance company directly for any reason, IGMS provides a gateway to register complaints with insurance companies.
Make use of IRDAI’s online portal IGMS
Many people often face a situation where the branch office of the insurer may not be willing to accept the written complaint and give an acknowledgment of the same. Or, the policyholder might face a problem in lodging his/her online complaint on the insurer’s website. In such scenarios it will be better to use IRDAI’s IGMS facility.
IGMS is a comprehensive solution which not only provides a centralised and online access for the policyholder but complete access and control to IRDAI for monitoring market conduct issues of which policyholder grievances are the main indicators. IGMS classifies different complaint types based on pre-defined rules. It assigns, stores and tracks unique complaint IDs. It also sends intimations to various stakeholders as required, within the workflow.
How to use IGMS
- Visit the website https://igms.irda.gov.in/
- Register yourself by entering your credentials
- Use Registered credentials to register complaints / view their status
It would be useful to keep the policy document ready while registering the complaint online. You can make optimum use of this system by giving accurate information about the complaint like the policy number, name of the insurer, complainant’s contact details etc.
A complaint registered through IGMS will flow to the insurer’s system as well as the IRDAI repository. Updating of status will be mirrored in the IRDAI system. In case the complaint is not fully attended to by the insurer within 15 days of lodging it, you may use the IGMS for escalating the complaint to IRDAI.
Send a letter to IRDAI with your complaint
If you are unable to use the online methods you can go for use the offline route. You can also download the IRDAI complaint form here and send your complaint through courier or post to the following address:
Consumer Affairs Department- Grievance Redressal Cell,
Insurance Regulatory and Development Authority of India(IRDAI),
Sy.No.115/1,Financial District, Nanakramguda,
Raise the issue with Insurance Ombudsman
If your complaint is still not addressed to your satisfaction, you can approach the appellate authority or the Insurance Ombudsman. The Insurance Ombudsman scheme was created by the government for individual policyholders to have their complaints settled out of the courts system in a cost-effective, efficient and impartial way.
There are at present 17 Insurance Ombudsmen in different locations across the country and any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee, make a complaint in writing to the Insurance ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential address or place of residence of the complainant is located.
There are certain conditions that you need to adhere to before approaching the Insurance ombudsman. As IRDA’s consumer education website https://www.policyholder.gov.in/ you have to first approach your insurance company with the complaint. However, if they have rejected it or did not resolve it to your satisfaction or have not responded to it at all for 30 days then you may approach the Insurance ombudsmen. Moreover, your complaint should be related to a policy which you took in your individual capacity and the value of the claim including expenses claimed is not above Rs 30 lakh.
How the settlement process works with ombudsman
Settlement by recommendation: The Ombudsman will act as mediator and will arrive at a fair recommendation based on the facts of the dispute. If you accept this as a full and final settlement, the Ombudsman will inform the company which should comply with the terms in 15 days.
Settlement by award: If a settlement by recommendation does not work, the Ombudsman will pass an award within 3 months of receiving all the requirements from the complainant and which will be binding on the insurance company. Once the award is passed, the insurer shall comply with the award within 30 days of the receipt of award and intimate the compliance of the same to the Ombudsman.
File a case in consumer forum or a civil court
If your grievance is still left unresolved after exhausting all other available options and you feel that your claim is justified, then you have the option to approach a consumer forum or a civil court. For instance, you can file a complaint with Department of Consumer Affairs at the following link https://edaakhil.nic.in/index.html.