How to file complaint for delay/non-settlement of insurance claims
If you have an Insurance Policy on personal lines, group insurance policies, policies issued to sole proprietorship & micro enterprises and have a grievance against an insurer (including its agents and intermediaries) or an insurance broker, complaint can be filed by Policyholder or claimant/legal heirs, nominee or assignee.
Step 1
First contact with the Insurance Agent/Broker/Bank/Online Portal from where you have purchased the Insurance Policy and ask for solution to settle the claim.
Next, you need to send email or fill up any grievance form to the Insurance Company. You can also connect in their customer support numbers.
Step 2
If the Insurance company branch does not reply properly you can escalate the grievance to higher authorities. The Insurer/insurance broker should deal with your complaint within 30 days.
For escalation of life Insurance Complaints you can contact senior officials – Click here
List of Grievance Redressal Officers Life – Click here
For escalation of Non or Insurance Complaints you can contact senior officials – Click here
List of Grievance Redressal Officers Non Life – Click here
Step 3
If you do not receive proper response from Insurance Companies you can approach IRDAI for filing complaints. IRDAI has launched Bima Bharosa portal which was earlier known as Integrated Grievance Response System.
To file complaint with IRDAI please click here to know more
Step 4
If you are unhappy with the solution or if there is no response to your complaint from the insurer/insurance broker as the case may be, within for 30 days, then you can approach the Office of Insurance Ombudsman as per jurisdiction for value of the claim including expenses not exceeding 50 lakhs, within 1 year from date of rejection/repudiation/partial settlement of claim by the Insurer/Insurance Broker.
Office of Insurance Ombudsman is an alternate Grievance Redressal platform which has been setup with an aim to resolve grievances of aggrieved policyholders against Insurance Companies and its Intermediaries or Insurance Brokers in a speedy and cost-effective manner.
To know more about Insurance Ombudsman please click here
Insurance Ombudsman only addresses complaints related to personal lines and Individual Insurance. Corporate Business does not fall under its ambit.
Other Methods
Filing of Claims with Consumer Forum
The Act provides for a three dispute Consumer Disputes Redressal Agencies. These are: District Consumer Disputes Redressal Forum in the District, State Consumer Disputes Redressal Commission at the state level and the National Consumer Disputes Redressal Commission at the national level.
To know more about jurisdiction and parameters please click here
Approaching Civil Court, High Court and Supreme Court
If the policyholder does not get suitable redressal they may file a suit in civil or high court. For Corporate Clients this is the only remedy. Any local lawyer may be approached to file suit in relevant Court.
Insurance Arbitration
Arbitration clauses in insurance policies are provisions that specify the method and forum for resolving disputes between the insurer and the insured. These clauses aim to provide a private, efficient, and binding method for dispute resolution, avoiding lengthy court procedures. In India, the inclusion of arbitration clauses in insurance contracts is guided by the Arbitration and Conciliation Act, 1996.
Expert Advise
If you want to get expert help of lawyer to deal with your case you can send a mail to approach a lawyer for guidance and support. They can help you in drafting of letters to insurance companies professionally. Please note the initial correspondance often becomes the basis of payment of Insurance Claim. If there is goofup in preparing the case it may severely effect the payment of final claim. It is always advisable to get drafting done through a experienced Insurance Professional. Please send brief facts of your case to support@bimabazaar.com to get more details.
