Grievance Mechanism And Insurance Ombudsman q To protect

Grievance Mechanism And Insurance Ombudsman

q. To protect the interest of policyholder. q. To have speedy and effective grievance redressal system q. IRDA has issued guidelines on 27 th July , 2010. q. Applicable for disposal of grievance/complaints

1. Definition 2. Grievance redressal policy 7. Minimum software requirements 8. Calls relating to grievances 3. Grievance officers 4. Grievance redressal system 9. Publicizing grievance redressal procedure 5. Closure of grievance 10. Policyholder protection committee 6. Categorisation of complaints 11. Turnaround times

Guidelines for grievance redressal v. Definition of grievance /complaint A “grievance” can be defined as any communication that express dissatisfaction about an action or lack of action , about the standard of service / deficiency of an isurance company and/or any intermediary or asks for remedial action.

INQUIRY AND REQUEST INQUIRY : - any communication for the purpose of requesting information about a company. REQUEST : -any communication for soliciting a service.

GRIEVANCEE REDRESSAL POLICY q. Every insurer shall have a board approved Grievance Redressal Policy which shall be filed with IRDA. GRIEVACE OFFICERS q. Every insurer shall have a Designated Grievance Officer of a senior management level. It includes: CEO /COMPLIANCE OFFICER

Grievance Redressal System An insurer send a written acknowledgement to a complainant within 3 working days of the receipt of grievance. Acknowledgement shall contain the name and designation of the officer. It contains the details of insurer’s grievance redressal procedure the time taken for resolution of disputes. If the insurer resolves the grievance within 3 days it may communicate the resolution along with acknowledgement. If the grievance is not resolved within 3 days, an insurer resolve the grievance within 2 weeks of its receipts and send a letter of resolution. The company sends the written response which offers redress or rejects the complaints and gives reasons for doing so.

Turnaround times Service level turnaround TA involved for the grievance redressal

Closure of grievance a) The company has acceded to the request of the complainant fully. b) Where the complaint has indicated in writing , acceptance of the response of the insurer. c) Where the complaint has not responded to the insurer within 8 weeks of the company’s written response. d) Grievance redressal officer has certified that the company has discharge its contractual, statutory and regulatory obligations.

Categorisation of complaints a) Categorisation of complaints shall be adopted by insurers and incorporated in their system from time to time. b) The present classification prescribed by authority is placed at annexure A.

Minimum software requirements q. It is necessary for insurers to have automated systems that will enable online registration , tracking of status of grievance by complainants and periodical reports as prescribed by IRDA. q. The objective is to create the required industry level database and that would enable speedy and effective redressal of complaints.

ØCall relating to grievance ØPublicizing grievance redressal procedure Ø Policyholder protection committee q. Every insurer shall ensure that Policyholder Protection committee, is receiving and analyzing the required reports from the management and is carrying out all other requisite monitoring activities.

PROCESS OF GRIEVANCE REDRESSAL Policyholder complaints IIRDS Grievance Call Centre GR Channel of the insurer IGMS Portal Insurer Does not responds Not satisfactory IRDA satisfactory closed Not satisfactory OCFCC

INSURANCE OMBUDSMAN Redressal of public grievances Rules, came into force w. e. f. 11 th November , 1998. institution of Insurance ombudsman was created to implement the above rule. Purpose : - 1. quick disposal of grievances 2. mitigate their problems 3. Protection of the interest of the policyholder.

Appointment of insurance ombudsman q. Insurance ombudsman can be appointed on the recommendation of the committee consisting: *Chairman of IRDA *Chairman of LIC *Chairman of GIC *Representative of central government

ØEligibility of ombudsman ØTerms of office ØTerritorial jurisdiction of ombudsman There are 17 Ombudsman across the country as on 1 st January, 2015 these are: - Ahmadabad Bangalore Bhopal Bhubaneswar Chandigarh Delhi Guwahati Hyderabad Jaipur Ernakulum Kolkata lucknow Mumbai Noida Patna Pune

ØOffice management ØRemoval of officer ØPowers of ombudsman Conciliation Award making

The complaint may relate to any grievance against insurer i. e. q. Any partial or total repudiation of claims by insurance companies q. Dispute with regard to premium paid or payable in terms of the policy. q. Delay in settlements of claims. q. Non issuance of any document to the customer after receipt of premium.

ØManner of lodging Complaint must be in writing and addressed to the INSURANCE OMBUDSMAN. Before lodging a complaint : q. The complainant should have made a representation to the insurer. q. The insurer either should have rejected the complaint or complainant have not received any reply within a period of one year. q. The complaint is not made later than one year after the insurer had replied. q. The same complaint should not be pending with before any court, consumer forum or arbitrator.

Recommendations of the Ombudsman q. Ombudsman shall make recommendation not later than one month and copies of the same sent to the complainant and the insurance company concerned. q. Complainant will send a communication in writing within 15 days of the date of receipt accepting the settlement.

Award q. Ombudsman shall pass an award within the period of 3 Months from the receipt of the complaint. q. If the policy holder is not satisfied , he can approach to other venues like q. Consumer Forums and courts of law.