Academy of BFSI,

Life Insurance Policy Holders – It’s Time to Know your Rights!

Let’s start with a case of Mr. Kumar and his family. It all started in the year 2013 when Mr. Kumar purchased a policy from one of the insurance companies.  Mr. Kumar got married to Kusum and was blessed with a kid. Kumar made a right decision to buy a life insurance policy and secure his family from any uncertain events. He purchased a term plan with the Sum Assured of Rs. 25 Lakhs for a premium of Rs. 8,000/- per year. After 5 years this story assumed an unexpected turn when Mr. Kumar died in an accident. This event brought emotional loss as well as a financial loss for his family.  Mrs. Kusum approached the insurance company to stake the claim for the term plan purchased by her husband. Kusum was taken aback with a rude shock when the life insurance company denied the claim on the grounds that Mr. Kumar had not disclosed all the required information about himself while purchasing the life insurance policy. This experience leaves Mrs. Kusum helpless.

Just imagine if we are in Ms. Kumar’s shoes, what would be our approach to get justice.

This article introduces consumer disputes redressal agencies, where consumers can approach to seek justice.

1 . IGMS

2. Ombudsman

3. Consumer Court

1. Integrated Grievance Management System (IGMS):-

The Consumer Affairs Department of the Insurance Regulatory and Development Authority (IRDAI) has introduced the Integrated Grievance Management System (IGMS) which is an online system for

Registration and tracking of grievances.

You must register your grievance first with the insurance company and in case you are not satisfied with its disposal by the company, you may escalate it to IRDAI through IGMS by accessing

www.igms.IRDAI.gov.in.

In case you are not able to access the insurer’s grievance system directly, IGMS also provides you below gateway to register your grievance with the insurer.

  • Grievance registration-through e-mail (complaints@IRDAI.gov.in)
  • Through the letter, address your letter to the Consumer Affairs Department, Insurance Regulatory and Development Authority, 3rd Floor, Parishram Bhavan, Basheerbagh, Hyderabad.
  • Through a call to IRDAI Call Centre at Toll Free 155255

The Call Centre assists by filling up the complaints form on the basis of the call.

IRDAI shall free of cost, register your complaints against insurance companies as well as help track its status. IRDAI Call Centre offers a true alternative channel for prospects and policyholders, with comprehensive tele-functionalities, from 8 AM to 8 PM, Monday to Saturday in Hindi, English and various Indian languages.

When a complaint is registered with IRDAI, it facilitates resolution by taking it up with the insurance company. The company is given 15 days’ time to resolve the complaint. If required, IRDAI carries out investigations and enquiries.

2. Ombudsman:-

The Insurance Ombudsman scheme was created by the Government of India for individual policyholders to have their complaints settled out of the court’s system in a cost-effective, efficient and impartial way.

There are at present 17 Insurance Ombudsman in different locations and any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee, make a complaint in writing to the Insurance ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential address or place of residence of the complainant is located.

You can approach the Ombudsman with a complaint if:

  • You have first approached your insurance company with the complaint and
    • They have rejected it
    • Not resolved it to your satisfaction or
    • Not responded to it at all for 30 days
  • Your complaint pertains to any policy you have taken in your capacity as an individual and
  • The value of the claim including expenses claimed is not above Rs 30 lakhs.

The settlement processes

Recommendation:

The Ombudsman will act as mediator and 

  • Arrive at a fair recommendation based on the facts of the dispute
  • If you accept this as a full and final settlement, the Ombudsman will inform the company which should comply with the terms in 15 days

 Award:

  • If a settlement by recommendation does not work, the Ombudsman will:

Pass an award within 3 months of receiving all the requirements from the complainant and which will be binding on the insurance company

Once the Award is passed

  • The Insurer shall comply with the award within 30 days of the receipt of the award and intimate the compliance of the same to the Ombudsman.

C. Consumer Court:-

If within 2 years of buying the product and services, you are not happy with the services of the insurance company and already lodge a complaint to Insurer and IRDAI and if you do not get a satisfactory response from IRDAI or Insurance company or Insurance Ombudsmen, you may approach Consumer Court for compensation.

Consumer courts are three tier structure –

  • If the value of goods and compensation is less than 20 lakhs, a case can be filed in a district forum. 
  • If the value of goods and compensation is more than 20 lakhs but less than one crore, a case can be filed in State Consumer Dispute Redressal Forum. 
  • If the value of goods and services is more than one crore, the case should be filed in the National Commission.

Filing a Petition in Consumer Court

You can file a petition in person or by an authorised agent through registered post. Within 2 years from the date of such deficiency occurred. No format is prescribed for filing a complaint. A complaint can be filed even on plain paper. The services of an Advocate are also not required. The case filed should be clear and precise. It should contain all facts, documents in support of evidence in an orderly manner. It should contain the following:

  • Name, Address, Description of the Complainant
  • Name of the Opposite party or parties
  • Cause and Facts relating to the complaint. Time and Place where it occurred.
  • Copies of documents in support of your petition (Keep one copy for yourself and file one copy in the court by duly signing it).
  • Send notice to the opposite party.

Along with the complaint, the complainant has required to file copies of supporting documents, i.e., cash memo, receipts, agreements, etc. The complainant is required to file 3 copies of the complaint, together with enclosures, for official purpose plus copies for the number of Opposite Parties.

The complaint should be filed along with fee in the form of Postal Order/ Demand Draft according to the amount of compensation claimed.

Cost of filing a case in Consumer Court

  • District court

For the value of goods and compensation 

Up to 1 lakh – Rs.100

Rs.1 lakh – Rs.5 lakh – Rs.200

Rs.5 lakhs – Rs.10 lakh – Rs.400

Rs.10 lakh to Rs.20 lakh – Rs.500

The specific fee should be in the form of crossed demand draft or crossed Indian postal order addressed to “President, District Consumer Dispute Redressal Forum”.

  • State Commission

For the value of goods and compensation

20 lakhs – 50 lakh – Rs.2000

50 lakhs – 1 crore – Rs.4000

The specific fee in the form of crossed demand draft or crossed Indian postal order must be sent to “Registrar, State Consumer Dispute Redressal Commission”

  • National Commission

For the value of goods and compensation above Rs.1 crore, the cost of filing a suit is Rs.5000.

The specific fee in the form of crossed demand draft or crossed Indian postal order should be sent to “Registrar, National Consumer Dispute Redressal Commission”.

With timely advice from her friend Mrs. Kumar lodged a complaint against the Life Insurance Company in the Ombudsman.  After careful verification of all records, statements, and evidence. Ombudsman found that the policy had been called in question after 5 years from the date of commencement of the policy at the time of death claim. As per the section-45 Insurance Act 1938, after 3 years policy cannot be questioned on material facts.  So finally, Ombudsman passed an award to the Insurance Company to settle the claim amount of Rs. 25 Lakhs to Mrs. Kumar.

About the Author:

Tarun Yaduwanshi has a work experience of 13 years. He started his career in sales with ICICI Prudential Life Insurance Corporation. Later he joined TATA AIA as a Branch Trainer, HDFC Life as a Training Manager and PNB Met Life as a Cluster Training Manager, before joining Manipal. Presently, he is associated with MABFSI since November 2015 as Deputy HoD with Life Insurance vertical.

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