HOW TO FILE A COMPLAINT AGAINST INSURANCE CLAIM REJECTION

Before starting with the process of filing a complaint against insurance claim rejection, firstly, we need to understand, what an insurance claim is and how is it useful for people.

Insurance claim works as an assurance by the Legislature or the Administrative Authority to protect the insurers from any kind of damages and loss they have suffered. It is a well-stated fact that ‘where there is a right, there is a remedy.’

If a person has availed the benefits of any policy or insurance relating to life, health, motor vehicle, property or any other valuable asset he may claim compensation from the Insurance Company after the maturity of the period of policy or even, when the person has suffered any loss or damage in any of these issues.

Even when a person completes all the documents and provides with all the details and information required for the insurance claims why there are situations that lead to the rejection of his claim? The answer to this question is simple.

There are a few points we need to focus, which leads to the rejection of the claim.

 

WHY A CLAIM IS REJECTED?

Even after fulfilling all the terms and conditions, the reasons that lead to the rejection of claim are:

• Incorrect Information–If at any stage, information given by the insurer is not correct.
• Lack of Due Care– In the cases, where you leave your valuable belongings in the display of a car or bus.
• Not giving correct answers and proper information to the insurance company.

Instead of panicking or taking unnecessary decisions in such situations, here are measures; a person could adapt to deal with the situation of an insurance claim rejection.

WHAT COULD BE DONE IF INSURER THINKS HIS CLAIM HAS BEEN WRONGFULLY REJECTED?

The steps involved to solve the matter are:

• GRIEVANCE REDRESSAL BY THE COMPANY:

If the situation arises, that claim is wrongfully rejected, the insurer can make the Complaint to the Company’s Redressal Officer at first.

The ideal time for acknowledgment is within 3 days and for the resolution is within 15 days. They can approach ombudsman if there is no response from the insurance company for over 30 days.

 

• GRIEVANCE REDRESSAL BY THE IRDA, IGMS, OMBUDSMAN

In cases, where the insurer is not satisfied with the company’s resolution, he can approach to the IRDA (INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA), IGMS (INTEGRATED GRIEVANCE MANAGEMENT SYSTEM), and OMBUDSMAN OFFICER.

 

IRDA

Only the policyholders can make a complaint before the IRDA Grievance Cell. There is no need for a Lawyer or any other person for filing a complaint on behalf of the Policyholder. While registering a complaint, all the details should be correct.  Aggrieved parties can contact Grievance Cell on the helpline number provided, or you can also  E-mail on the official website.

IGMS

If the complaint made to IRDA remains partly / fully unattended, for over 15 days, you can visit the official website to register and track the status of your complaint.

 

OMBUDSMAN

* The  Government of India started this scheme to resolve the dispute outside the courts. The aggrieved party can approach the Ombudsman if there is no response from the company for over 30 days.

* they should file Complaint with the Ombdsman Officer under whose Jurisdiction the branch or Office of the company falls.

* The value of the insurance claim shall not exceed 20 Lakhs.

* He hears both the parties and fairly and unbiasedly decides.

*Decision given by Ombudsman officer is final and binding on the    Insurance Company.

 

• After hearing both the parties, the Ombudsman Officer has the power to make the insurance company:

 

* Explain their actions

* Apologise to the Policyholder

* Give Compensation or take any other step to change the outcome.

 

CONCLUSION:

 

And lastly, if the insurer still feels unsatisfied with the decision made by the Ombudsman, he can approach to the Civil Courts and Consumer Forums which has the Jurisdiction.