CHAPTER -3
GRIEVANCE REDRESSAL MECHANISM
Grievance redressal mechanism – IRDA has various regulations in order to render the consumers grievances/complaints which come under protection of policy holder”s interests‟ regulation 2002.
- i) Integrated grievance management system (IGMS) – IRDA has launched an integrated grievance management system (IGMS) which acts as a central repository of insurance grievance data and as a tool for monitoring grievances in the industry. Policy holders can register on this system with their policy details. Complaints are then forwarded to the respective insurance company.
- ii) The consumer protection act 1986 – the act was passed “to provide for better protection of the interest of consumers and to make provision for the establishment of consumer‟s disputes”.
Service – any provision made available to potential users such as banking, financing, transport, insurance etc.
Consumer – any person who buys any goods for a consideration or hires or avails of any services for a consideration.
Defect – it means any fault, imperfection, and shortcoming, inadequacy in quality, nature, manner or performance for any service that is taken by the customer.
Complaint – it means any allegation given in writing regarding any unfair trade, defect in goods, deficiency in services hired or availed, excess pricing.
Consumer dispute – it means a dispute where the person against whom the complaint is made, denies and disputes the allegations made on him.
Ombudsman :
- Total office of ombudsman in India – 12.
- The Ombudsman power is restricted to the value not exceeding Rs.20 Lacs
- Recommendations should be made within 1 month of the receipt of a complaint
- The complainant has to accept the recommendation in writing within 15 days of receipt of such recommendation.
- The insurance companies are required to honor the AWARDS passed by Ombudsman within 15 days.
- If the dispute is not settled, the Ombudsman will pass an award to the insured within 3 months/90 days from the date of receipt of the complaint.
- The insured should acknowledge within 1 month of receipt of such award.
Complaints can be made to the ombudsman if :
The complainant had made a previous written representation to the insurance company and the insurance company had :
- Rejected the complaint.
- The complainant had not received any reply within one month from insurer.
- The complainant is not satisfied with the reply given by the insurer.
- The complaint is made within one year from the date of rejection by the insurance company.
- The complaint is not pending in any court or consumer forum.
Judicial Channels :
NATIONAL COMMISSION
- Established by central
- Government by notification.
- Complaints of Claim value exceeding Rs. 1 Crore and
- appeals against the order of any state commission.
State commission
- Established by state govt. by notification.
- Complaints of Claim value exceeding Rs.20 Lakhs but does not exceed Rs.100 lakhs and
- appeals against the order of any district forum within the state.
District forum
- Established by state govt. in each district.
- Complaints of Claim value up to Rs. 20 lakhs
Important Days :
- 10 days – Insurer has to communicate the policy holder on any inquery.
- 15 days – Customer can cancel the contract within 15 days of receiving the policy (Free look period/Cooling off period).
- 15 days – Insurer has to convey the policy holder about acceptance or rejection of proposal.
- 15 days – In case of claim insurer can ask for additional documents within 15 days of receiving the claim documents.
- 15 days – Insurer has to honor the Award passed by the ombudsman within 15 days.
- 15 days – Grace period in case of monthly mode of premium payment.
- 31 days or one month – Grace period in case of Quarterly/half yearly/annual mode.
- 30 days – ombudsman has to pass recommendation.
- 30 days – Insurer has to settle the claim within 30 days after receiving the claim document.
- 90 days – Ombudsman has to pass an award within 90 days.
- 180 days – maximum time in case of disputed claims.
