Moneycontrol
Jun 19, 2017 12:46 PM IST | Source: Moneycontrol.com

Insurance claim rejected? Here's what you should do

If the insurer fails to resolve the grievance within the stipulated time, a policyholder can approach the Insurance Regulatory and Development Authority of India (IRDAI) within a year.

Insurance claim rejected? Here's what you should do

Moneycontrol News

An insurance policy is bought to secure the future, but what if the claim is rejected by the insurer?

Here are the steps to follow if the claim is rejected:

Approach the insurance company

-Reach out to the Grievance Redressal Officer (GRO) of the insurance company.

-Provide the complaint in writing along with the necessary support documents

-Always take a written acknowledgement of the complaint with the date.

The insurance company should resolve the grievances within 15 days.

However, if the insurer fails to resolve the grievance within the stipulated time, a policyholder can approach the Insurance Regulatory and Development Authority of India (IRDAI) within a year.

Approaching the IRDA

The complaint can be forwarded by email to complaints@irda.gov.in

Or, complaints can be mailed to the IRDAI head office situated in Hyderabad.

According to IRDA, a complaint should  state clearly the name and address of the complainant, the name of the branch or office of the insurer against whom the complaint is made, the facts giving rise to the complaint, supported documents if any, the nature and extent of the loss caused to the complainant and the relief sought from the Insurance Ombudsman.

The Ombudsman gives his recommendation within one month if parties agree to a mediation; otherwise, an award is passed within three months from the date of receipt of all requirements from a complainant.

An insurance company has 30 days to comply with the award. However, if the complainant is unhappy with the award he or she can approach the consumer forum. The award is binding on insurance companies, though.

Integrated Grievance Management System (IGMS)

Besides these, IRDA has come up with an Integrated Grievance Management System. Policyholders can use this system to register and track their complaint, both with the insurer and the IRDA.

-Log in to igms.irda.gov.in and create a profile for registering a complaint.

-Fill in all the necessary details related to the grievance.

A complaint registered through IGMS flows to the insurer’s system as well as the IRDA repository.

The complainant would receive a confirmation email after registering the complaint along with IRDA token number which will be used by IRDA and Insurance Company for tracking of the complaint through IGMS.

Once a complaint is registered to the IGMS, the details of the complaint are passed on to respective insurance companies.

If the complainant is not satisfied with the resolution provided by Insurer, the complaint can be escalated for a review by IRDA for a potential violation of Regulations through IGMS.
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