How to get insurance complaints resolved when your insurance provider does not act?

Insurance is one of the most important investments that you need to make to safeguard the financial well-being of your business or investment to protect it from any harm. Many of us depend on insurance in case we encounter a personal loss that affects us and leaves us devastated. In these situations, it may be difficult for us to keep our calm and follow through on the process of successfully filing a claim of damages with the insurance provider and work to provide the necessary paperwork. In the case of an insurance policy, several things need to be in place for the claim to get processed. Let us first look at these factors that may delay your insurance claim.

• Record of up to date premium payment – Your premium payment details are very important since they determine your coverage under the insurance policy. You need to make sure that the latest payment of the insurance premium has been carried out and the records are available with us.

• Updated beneficiary details – The nominee or beneficiary details of the insurance policy must be updated regularly to avoid any confusion or delays. Beneficiary details must include their contact information, and in the case of a minor, a guardian must be listed as well.

• Delay in filing – The claim must be filed within the stipulated period after the event has occurred according to the insurance policy. Delay in filing the claim can even get the claim rejected. 

• Correct information of the insured – Whether you have insured property, a life, a vehicle, or the health of someone, ensuring their correct and up to date information can make sure that your claim is processed with slight delay.

Despite keeping these factors in mind and ensuring that everything from your side is done in the right way and within the prescribed timeframe, you can still face delays from the insurance provider. It may also happen that the Insurance Provider does not act at all on your insurance complaint. You can check the insurance policy as issued by your insurance provider and find out the maximum time that they can take to process the insurance claim or insurance complaint. If you are not satisfied with the actions of your insurance provider or suspect them of unjustly delaying the processing of your insurance claim, you can escalate the matter to Ombudsman. The Ombudsman can be approached if the insurance claim has not been responded to by the insurance provider within 30 days of filing the insurance claim. Apart from this, the Ombudsman can also be approached if the case has been rejected by the insurance company or has been resolved but not to the satisfaction of the insured.

The Insurance Ombudsman can be approached for out of court settlement in a cost and time-effective way so that you can challenge the actions of the insurance company whether it is a delay in the processing of your insurance claim or rejection of the same. The Ombudsman will oversee the insurance complaint and following that will give his recommendation within 1 month if both you and the insurance company agree to the mediated. If that does not happen, the Ombudsman will pass the award within 3 months from the complaint date. This decision will have to be complied by the insurance company however in case you want, you can move to the court of law again the insurance provider if not satisfied by the decision of the Ombudsman. Once the Ombudsman has passed an award the insurance provider must comply within 30 days to comply with the decision provided you too have accepted it as a full and final settlement amount.

Apart from approaching the Insurance Ombudsman, you may also register your grievance at the Insurance Regulatory and Development Authority of India or IRDAI directly. IRDAI recommends that you should approach the Grievance Redressal Officer of the Insurance provider with a written complaint or send them an email and get a written acknowledgment from them of your formal complaint. If you do not receive a resolution from the insurance provider within 15 days of lodging your complaint with the Grievance Redressal Officer, you can escalate the matter to IRDAI addressing it to the Grievance Redressal Cell of Consumer Affairs Department of IRDAI. Through the IRDAI website, you can get information such as the toll-free number for the Grievance Redressal Cell and the email address to send your complaint.

For any insurance complaints including unjustified delays from the insurance provider, you can approach the Insurance Samadhan where we can help you get a quick and easy resolution to your insurance complaint and related queries. We have an online portal that you can use for the redressal of your complaint while having our experienced insurance industry experts represent you through the entire process of negotiating and dealing with the insurance company. You can approach us at any stage of your insurance claim and leverage our expertise in the insurance industry to make informed decisions regarding your options in your insurance claim and complaint.