How to redress your grievance online

Shilpy Sinha & Preeti Kulkarni, ET Bureau 

The protection of policyholders' interest, it seems, is on the top of the agenda of the Insurance Regulatory and Development Authority (Irda). Through a media campaign, it has increased focus on educating policyholders and publicising the grievance redressal mechanisms. 

It has also introduced the Integrated Grievance Management System (IGMS), a platform to help customers lodge and track their complaints online. The regulator also has a grievance cell, besides several Insurance Ombudsman offices. 

Consumer activists are still sceptical about the series of steps being taken by the regulator to protect policyholders' interests, but one cannot deny the need for a campaign to create awareness about the intricacies of the existing grievance redressal mechanism.
In case of life insurance, grievances pertain to unilateral change of policy terms and conditions after issuing a policy, and rejection of claims on grounds of suppression of material facts by the insured. 

In general insurance, the list includes non-settlement or partial settlement of claims, delay in approving the claim, refusal to renew health insurance policies and loading of premium. 

Whatever be the grievance, your first stop for redressal has to be your insurance company. You can register your complaint through a branch office, phone, email , website, etc. You can also approach the company's grievance redressal officer. 

Insurers are required to acknowledge your complaint in writing within three working days of its receipt. The grievance redressal norms also require the company to specify the period by when it is likely to be resolved. 

If a resolution is effected within three days, you will be intimated. If not, the company will have two weeks to send a final letter of resolution. But, if your complaint is rejected, the company has to disclose the reason and also inform the policyholder about other redressal avenues available.
The next step is to take your grievance to the regulator through IGMS, IRDA Grievance Redressal Cell or the insurance Ombudsman offices. Most companies barring a dozen are now integrated on the IGMS platform. The idea behind setting up the IGMS is to monitor complaints and analyse patterns. 

The nature of the complaints varies, but the most common complaint in life insurance is that of policy bond not reaching customers. In case of nonlife, it is non-settlement of claims. Once we receive complaints we escalate the case to senior executives of insurance companies. 

With IGMS, you can route your complaint through the newly launched website (www.igms.irda.gov.in). You need to register yourself on the portal to file and, later, track your complaints. Once lodged, the complaint is forwarded to the insurer concerned. 

The details of the complaint can be viewed online by the consumer, the insurance company and the Irda. A token number is provided by Irda for subsequent follow-up. However, no action is taken on the complaint by Irda, and it is for the insurance company concerned to deal with the grievance.
This apart, Irda already has a grievance redressal cell in place, which would be your next stop should the insurer fail to resolve your complaint. 

You can do so by dialing 155255 or by sending an email to complaints@irda .gov.in. 

The cell does not pass orders, but complaints received are taken up with the insurers. 

Do not rely on others to file your complaint, as the ones sent in by third-parties like lawyers or agents are not considered by the cell.
Unlike the Grievance Cell, the Ombudsman has the power to pass orders. It addresses issues related to rejection or delay in settlement of claims, disputes on premiums, and non-issuance of a document after collecting the premium. Complaints have to be filed with the Ombudsman office under whose jurisdiction your complaint will fall. 

Cases entailing a value of up to Rs 20 lakh fall in the ambit of Ombudsman's powers. Recommendations can be made within a month of the receipt of the complaint, while a verdict has to be given within three months. If need be, the Ombudsman can also award compensation to the policyholder. 

The Ombudsman is appointed by the Insurance Council and is supposed to be independent; the order passed by the Ombudsman is binding on the insurance company, but it is open to the insured whether to accept the award or file a consumer complaint if he/ she is dissatisfied with such an award. 

If you feel the order is in your favour, you are required to intimate the Ombudsman within 15 days. You can also approach consumer forums or civil courts for relief if the insurer fails to comply with the Ombudsman's order or you are not satisfied with it.