Insurance Claims

 





Tired of chasing an insurance claim or rejection? Get a grasp on the redressal framework

 

When Mumbai resident MK Shedha travelled to Geneva two years ago on an official trip, he bought a travel insurance policy from a private general insurer. His ordeal began when his baggage was stolen at the airport. The insurer rejected his baggage loss claim.

After following the grievance redressal mechanism at the company level, Shedha approached the insurance ombdusman, which awarded him `3,000. Unhappy with the verdict, he moved the consumer court and won `80,000 in compensation, which included 6% interest on the original estimated loss.

This case highlights the impor tance of taking your insurer to task, instead of meekly accepting technical arguments for rejecting claims.

RULES ON HANDLING GRIEVANCES

The entire process is governed by t h e I R DA P ro t e c t i o n o f Policyholders' Interests (PPHI) Regulations 2002. The regulator issued detailed guidelines specifying turnaround time in July 2010. The insurer is required to send a written acknowledgement to the complainant within three work plainant within three woing days, mentioning the name and designation of the officer in charge of resolving the grievance, in addition to details of the redressal process. The maxi mum turnaround time for resolving complaints is two weeks. If the com plaint is rejected within two weeks, the insurer has to give reasons for the same and guide the policy holder on recourse op tions. You can also regis ter your complaints through the regulator's Integrated Grievance Management System portal (igms.irda.gov.in).

THE NEXT LEVEL

If you are unhappy with the company's response, you can approach the insurance ombudsman's office in your city 30 days after complaining to the insurer. It is a quasi-judicial body which deals with cases involving up to `20 lakh and has the power to award compensation to policyholders. For simpler complaints, IGMS is the answer (see chart).

FINAL RECOURSE

Consumer courts are the last resort for a policyholder. You need not approach the ombudsman before knocking on the consumer courts' doors--you can do so directly.

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