How To Complain Against An Insurance Company In India

Published on 29 Jun 2018 by Shivi

With a hope to protect your dear ones and your own life, health and property, you invest in a befitting insurance policy, pay a regular premium and expect that the policies will protect you from any kind of loss in form of life, health or property.

Upon receiving a regular and timely payment of insurance premium, the insurance company provides a financial safeguard to the person against unexpected losses relating to his health, property and life. The insurance policy binds the insured person to pay timely premium and insurer (insurance company) to pay for the losses suffered.

There may come a time when the policyholder (insured) is left stranded when the insurance company refuses to accept the policy claim, fails to make the due payment or outrightly rejects the claim. When there is no foul play in this delay, refusal or rejection, technical snags or glitches might be the ones to be blamed. However, in a case of any default or fraud on part of the insurance company, the best option for the policyholder is to go the legal way!

Legal Action Against Insurance Company

Before initiating any kind of legal action, the policyholder must first contact the insurance company and try to settle the matter directly. A written complaint, along with the requisite documents must be sent to the insurance company. Every insurer has a grievance redressal officer who deals with the complaints received.

An insurance company is bound to give an appropriate reply to the complaint within 15 days. If the insurer fails to send a reply to the grievance received, a complaint can be filed with the IRDA. It is always advised to consult an insurance lawyer in India to file a complaint with the IRDA.

IRDA or the Insurance Regulatory and Development Authority is the primary statutory body that supervises and regulates the insurance sector in India, created by the IRDA Act. IRDA aims to promote and protect the interest of policyholders in India and ensures speedy redressal of insurance claims prevention of fraud and malpractice by insurance companies.

The Integrated Grievance Management System (IGMS) was introduced by the IRDA to file a complaint against the insurance company online. An insurance advocate in India can file a complaint online on behalf of the policyholder and a unique complaint ID is issued to the department in question for dispute resolution.

Complaint With Insurance Ombudsman

The Insurance Ombudsman is another authority which can be contacted to file a complaint against an insurance company. Any individual or his legal heirs can file a complaint with the insurance ombudsman. A good insurance attorney in India can be hired to file a complaint with the insurance ombudsman if the total value of the claim is up to Rs. 20 lakhs.

The following kinds of insurance matters can be taken up by the insurance ombudsman:

  1. Partial or complete repudiation of an insurance claim.
  2. Dispute relating to the amount of premium paid or payable.
  3. Legal construction and interpretation of a policy relating to an insurance claim.
  4. Delay in settlement of insurance claim.
  5. Non-issuance of a policy after the premium is paid.

A complaint with the insurance ombudsman can be filed within 1 year from the date rejection, refusal or delay in an insurance claim.

Consumer Complaint Against An Insurance Company

If the complaint has not be resolved by approaching the IRDA or the insurance ombudsman, a complaint can be filed with the appropriate consumer forum with the help of a consumer complaint lawyer in India. There are three tiers of consumer forums in India:

  1. District forum: A complaint can be filed when the total value of the insurance claim is less than Rs. 20 lakhs.
  2. State Commission: A complaint can be filed when the total value is more than Rs. 20 lakhs but less than Rs. 1 crore.
  3. National Commission: A complaint can be filed when the total value is more than Rs. 1 crore.

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