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Customer Protection

Chapter 14

  1. Free look time available after receiving policy documents is 15 days.
  2. The charges were not fully disclosed to the customer is a common complaint against Agents.
  3. Kartik written to his insurer about non settlement of maturity claim, as per the regulation insurer has to reply to this within 10 working days.
  4. Ombudsman is created in 1998.
  5. Complaint council body other than IRDA grievance redressal forum & COPA would be Ombudsman.
  6. Total 12 Ombudsman offices located in India.
  7. Mr. A is working as a Nodal Officer in Insurance company dealing with handling complaints.
  8. De-tarrification is a process by which insurance can price their product on their self past experience.
  9. Consumer Affairs Department (CAD) is established by IRDA to deal with customer complaints.
  10. Ombudsman has to give his decision within 30 days.
  11. Customer can contact to forum at state level in case of any dispute for a claim more than 20 Lakh.
  12. Ombudsman is a complaint council body other than IRDA Grievance redress and COPA to get his grievances against the insurance company.
  13. Stipulated time frame within which an insurance company supposed to respond after receiving communication from its policyholder is 10 days.
  14. Life insurance policyholder is entitled to refer complaint to insurance ombudsman referral is made in maximum period of one year from response by insurer.
  15. Group insurance can be taken in employer-Employer relationship.
  16. As per IRDA regulations setting up IGMS would help in effectively handling Grievance of the customers.
  17. Insurance Ombudsman has bee appointed to protect the interest of policyholders.
  18. When the insured disagree with any of the term & conditions of the policy is issued, they have the option to return the policy
  19. On submission of complaint against an insurer to the Ombudsman decision is made in favour of the policy holder within 15 days.
  20. “Policy holders protect regulation” insist that all insurance companies should provide the information about the insurance Ombudsman of that region while sending the policy documents.
  21. Insurance companies are required to honor the award passed by insurance ombudsman within 15 days.
  22. If the complainant is disagree with the decision of the company on the claim then he can approached to Ombudsman in 1 month.
  23. Pooling of risk apply to all type of Insurance.
  24. Life insurance policyholder is entitled to refer complaint to Insurance Ombudsman referral is made in Max period of 1 year from response by Insurer.
  25. AML program of every insurer to include Inspection by Auditor General apart from procedure training & audit.
  26. If any consumer is dissatisfied with the customer care cell of any Insurance company then he can escalate their grievances to Nodal Officer.
  27. Policyholder can make complaints either via E-mail (complaints@irda.gov.in) or Toll free number 155255.
  28. Consumer can call Toll free No. for any Grievance or he can also contact consumer affair department of IRDA, Insurance Ombudsman & Insurance company.
  29. 5000/ is the Minimum Sum Assured allowed for Micro Insurance.
  30. Grievances can be taken up to the Ombudsman like Partial or Total repudiation of Claims by the insurer, Dispute with regard to premium paid or payable & delay in settlement of claims.
  31. As per regulation for protection of policyholder’s interest 2002(IRDA) that All insurer will have a grievance redressal system.
  32. Insurance contract of value not exceeding Rs. 20 Lakhs is the limit of Ombudsman claim settlement.
  33. If a policy holder buys a policy from the advisor and lodges a complaint, it should be treated as same for all policies sold by advisor.
  34. Regulation issued by IRDA required that the decision on the proposal must be conveyed to the proposer within 15 days.
  35. To ensure that the customer complaints are handled effectively, IRDA has established “Integrated Grievance Management System”.
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