Solving insurance problems just got easier

BY DEEPTI B HASKARAN

In what could be seen as a message to the insurance companies to pull up their socks in terms of being custom- er-friendly, the insurance regu- lator is flashing a message for the customers. The Insurance Regulatory and Development Authority (Irda) has been re- cently capturing prime space in newspapers and news channels to circulate a toll-free number that promises to quick-fix your grievance if the insurance com- pany turns a blind eye.
Earlier, at times, it took months before you could get even a small mistake rectified.
But not anymore. If your insurer hasn't addressed your problem despite repeated reminders, you now have a direct recourse with Irda--call up toll-free number 155255 or email at com- plaints@irda.gov.in. And this comes only later in the chain.
Grievance redressal Perhaps, you may not need to approach Irda at all. Before you knock at Irda's doors, you would need to take up the mat- ter with the insurer first. But here, too, you have assistance.

At the insurer level: To fur- ther facilitate the settlement at the insurer level itself, Irda has put in place fresh guidelines, effective 1 August, which man- date a separate grievance poli- cy for every insurer.

The grievance cell will be presided by the chief executive officer or the compliance offi- cer of the company. Also, the insurer will now have systems that will enable you to register a complaint online, through call centres and even accept postal complaints. According to Irda guide- lines, it is mandatory for the insurers to apprise all policy- holders --existing and new--of their grievance policy.

In a move that could prove re- ally helpful for customers, Irda has come up with a list of com- mon problems faced by policy- holders. These pertain to servic- ing and claim-related issues.

With each of these prob- lems, the insurer has men- tioned a turnaround time, which could be as low as a few hours. For instance, the insur- er needs to address the prob- lem of a wrong policy issue in 10 days, while the turnaround time on the issue of non-pay- ment of death claim is 30 days.
To see full list, go to www.irdaindia.org/grievance/ classifications_final.xls.

The insurer may choose to set- tle the claim earlier than the stip- ulated time, but not after that. If the insurer fails to meet the deadline in servicing your com- plaint, you can take your grouse once again to the insurer's door- step, but through a separate win- dow--grievance cell.

At this level, too, Irda has a help mechanism in place. As per the new guidelines, the company will need to acknowl- edge your complaint within three working days and re- spond within 14 days.

If you are dissatisfied with the settlement, you get about eight weeks to reply to your in- surance company. In the ab- sence of any such objection, the insurer will consider the complaint settled.

“The new guidelines have standardized the whole process of tending to and settling com- plaints and problems. Earlier, despite having a grievance re- dressal policy, the process was not effective, but now the regu- lator has mapped the turn- around time for each category of service and has also put in place a time limit to settle griev- ances. The regulator will now be able to tap into our database to see how many complaints are settled leading to transparency.
For the consumer, this only means speedy redressal,“ says Anand Pejawar, executive direc- tor and marketing head, SBI Life Insurance Co. Ltd.

At the regulator level: If you are not satisfied with the set- tlement, you can approach your insurer again or can di- rectly go to Irda. You can also approach the regulator if your insurer refuses to entertain your complaint. “The grievance mechanism we have in place is only for complaints that do not need le- gal intervention. We are step two after the policyholder is not satisfied with the settlement done by the insurance compa- ny or has not heard from them,“ says an Irda official in the consumer affairs depart- ment, who did not want to be quoted.

The regulator will ask for your complaint reference number and then will follow up with the insurer on your be- half. But does this mean a sure shot settlement? Yes. “We will look into the matter immedi- ately. Also, we may take regu- latory action in case we find the insurance company is not settling the claim or is being unfair,“ says the Irda official.

Last resort: With Irda's new redressal mechanism in place, chances of a rift would be min- imal. But if you are still not sat- isfied and the sum assured on your policy is less than Rs20 lakh, you can approach the in- surance ombudsman.

Every area has a separate ombudsman and your insurer will have information about who is your ombudsman. The verdict of an ombudsman, which needs to be issued with- in three months of a complaint, is binding on insurers. But the policyholder can challenge the verdict at consumer forums or take the matter to the court.

Now that Irda has put in place a redressal mechanism, the onus is on you to get your problems solved.