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How to even out grievances against insurance company?
How to even out grievances against insurance company
?Note this. A person undergoes three surgeries simultaneously, incurring a total cost of 33,000. When the claim was lodged, the insurance company's third-party administrator (TPA) held that though the surgeries pertained to three different body parts, these were conducted at the same time and, hence, the eligible claim was only 10,000. If the person would have had each surgery on different days the cost would have been much higher!
Now the question is what to do about this problem? Simple, approach the insurance ombudsman; chances are that they would understand and give correct judgment.
Like above there are many examples where the insurance companies try to shirk off their commitment to policyholders. Here under is the process that can help you resolve your grievances with your insurers:
First Step:
Insurers have various channels through which one can register complaints with them. Like branch office, phone, e-mail and posting a letter (snail mail) etc. This way you can also approach the company's grievance redressal officer. It is necessary for the insurer to send a written acknowledgement within three working days of receiving the complaint and specify the period within which grievance is likely to be resolved.
In case the complaint is resolved within three days, the insurer has to inform the individual along with an acknowledgement.
If not, the company will have to resolve it within two weeks of receiving the complaint and send a final letter of resolution to the aggrieved.
If the insurance company decides to reject the complaint, it has to give a reason, along with information on further redressal avenues, which the complainant can pursue.
In case you are not satisfied with the insurer's response, you have to inform it within eight weeks, or the company will assume that the complaint has been resolved.
Second Step:
If the first step proves useless you have you options, depending on the nature of the complaint to Contact either:
1. Irda's Grievance Redressal Cell:
Though this cell does not have the authority to pass orders, complaints addressed to it are taken up with the insurers. These could include delay or lack of response pertaining to policies or claims and complaints about agents' conduct. Irda has a toll-free number, (155255). It has revolutionized the process of grievance redressal. IT has also helped create awareness among public about the alternatives available to policyholders. You can approach the cell directly, and where required, you will be redirected to the ombudsman under whose jurisdiction the complaint falls. You can get in touch with the cell via mail as well (complaints@irda.gov.in). Ensure that you send the complaint yourself as the ones forwarded by third parties, including lawyers or agents, are not entertained by the cell. Also, the complaint should have complete information. So, disclose all the details in the complaints registration form available on Irda's website.
OR
2. The insurance ombudsman
The ombudsman can make recommendations within one month of the receipt of the complaint and give a verdict within three months. If necessary, he can award compensation to the policyholder. If you are satisfied with the settlement, you have to send your acceptance within 15 days. If the insurance firm does not comply with the order, you can approach consumer forums or civil courts. These offices handle cases dealing with insurance contracts with a value of up to 20 lakh.
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