Are you not satisfied with your insurer? Here’s how to file a complaint via the IRDAI portal

Are you not satisfied with your insurer? Here’s how to file a complaint via the IRDAI portal

New Delhi: There may be various reasons why an insured may want to file a complaint against an insurance company. Policyholders may wish to file a complaint related to the purchasing process, the claims process or requests for generic services such as change of address, contact details, appointments, offer of a certificate of savings. tax, changes in payment method, etc.

Some of the reasons maybe:

Complicated clauses leading to litigation

Although simplifying insurance policy wording has been on the agenda of the Insurance Regulatory and Development Authority of India (IRDAI) for a long time, policies continue to be riddled with complex clauses. The ombudsman’s report lists the proportional deductions, the increase in the sum insured, the active line of treatment and the customary and reasonable costs among the clauses that require recasting or an appropriate interpretation.

Rejection of application due to late notice

IRDAI asked the insurers not to refuse the claims on the sole ground of delay in the formal notice. IRDAI defends IRDAI’s position that the prescribed deadline for filing documents should not hinder the settlement of actual claims.

Leave the decision-making to the APTs

The IRDAI 2016 health insurance regulations specify that it is the insurer, and not the third-party administrator, who must be the final decision-making authority. Still, the offices of the Insurance Ombudsman noted that most general insurers do not have an established system for reviewing claims rejected by PTAs.

Poor grievance mechanism

Another lack of service pointed out by the insurance ombudsman’s report is linked to a lack of personalized responses to the grievances of policyholders.

If the insurance company does not address the problem within the allotted time or provides a satisfactory solution, the complainant can also register their complaint with the Grievance Unit of the Department of Consumer Affairs of IRDA. If you have a complaint against your insurance company, here are some ways to register it.

How to file a complaint via the IRDAI portal:

The complainant can file a new complaint or forward it to the Integrated Complaints Management System (IGMS) by visiting the igms.irda.gov.in website, using an IRDAI online recourse portal. IGMS allows the complainant to modify their complaint halfway. Make sure that before contacting IRDA, you must file a complaint with the relevant insurance company.

This can also be done by calling a toll free number 155255 (or) 1800-4254-732 or by sending an email to [email protected]

After receipt of the complaint, a token number will be generated and given to the complainant. It will be sent to the insurance company for review and response within two weeks. If the response received is not satisfactory, the complaint is then forwarded to the insurance mediator or consumer forum, or to the civil court depending on the nature of the complaint.

If the claim is not fully processed by the insurer within 15 days of filing, you can use the IGMS to send the claim to IRDAI.

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