Customers can bring down institutions, brands and products. Organizations therefore take utmost care in laying out detailed guidelines for “grievance redressal”. Arbitrators or ombudsmen are appointed for looking into contentious issues which cannot be resolved at the lower level. They act as a referee and try to reconcile the misgivings which the customer may be facing.
For insurance companies the role of the arbitrator is all the more important as the product is of intangible nature. The Insurance Ombudsman, as he is called, is vested with powers to handle disputes based on laid down rules and policies
Customers often face problems regarding their claims, premium payments and policy documents. In case of any grievance, they need to contact the insurance office concerned and lodge a complaint. If no response is received within 30 days, or if the response received is not to the satisfaction of the customer, then he or she may approach an insurance ombudsman.
What is the origin of the ombudsman?
On the 11th of November 1998, the Government of India, set up the post of ombudsman with the aim of fostering trust between the insured and the insurer. The role of facilitator for dispute resolution and protection of customer rights are performed by the ombudsman.
When To Approach The Ombudsperson
Being an intangible product, insurance policies, once in dispute, come with complicated consequences and a lot of legal gauntlets. The preliminary steps towards lodging a complaint involve a written document, via letter or email.
The insured has to approach the insurance company first, no matter what, and then apply the wait-and-watch policy. 30 days past, if there is no response from the company’s side, then you can approach the Ombudsperson provided you have not taken this case to any consumer’s forum or consulted an advocate.
What The Ombudsperson Deals With
There is a list of points on which the Ombudsperson can move against the insurance company.
- If the insurance company rejects a complaint unlawfully without citing a proper reason, you can move to Ombudsperson without delay
- If the insured does not receive the stipulated claim even after the insurance company has acknowledged the same.This is the most serious offence and should be dealt with strict hands
- The company does not comply with the terms and conditions laid down in the policy rule
- There is adelay in processing the claim in need beyond the specified time.This falls under the IRDAI Act, 1999.
- If a sizeable premium is asked of the insurance customer, but the payable amount is not up to the mark.
- Lastly, for a non-provision of policy documents after the customer has successfully paid the premium for the same
The insurance company is answerable to the ombudsperson once his verdict is placed. The complainant will hear from the ombudsperson’s office within three months of filing the complaint. Even after that, if you are still dissatisfied with the verdict and need to review then the next step beyond the Ombudsperson is the consumer forum and then finally the court.
Currently, 12 ombudsperson offices are stationed all across India. These offices can deal matters interstate and are hence not necessarily territorial. However, the complaint has tobe lodged within the jurisdiction of which the insurance company is concerned.
The work of an ombudsperson is like being a referee in a football match. For every serious foul committed, the ombudsperson will take over to come to a conspicuous decision. Certain rules and policies especially laid down for the ombudsperson give them the leverage to handle the policy disputes.
What You Need For Official Documents
IRDAI (the Insurance Regulatory and Development Authority of India) intervenes in the matters of settling policy disputes and deploying Grievance Redressal Officers or GROs before ombudsmen come to the scene. All your supporting documents must be in order to make the process seamless because the procedure is lengthy.
Why The Settlement Almost Always End Up In Disputes
The companies guard against fraudulent insurance claims, and because these cases are on the rise, the insurers have an innate tendency to delay the claim process just to test the waters. Constantly reassessing the policies make it difficult for even the honest of claims to be settled.
According to the articles stated in the survey dated 2010-11 by Ernest & Young (Fraud in insurance on therise), there is a serious need to take gritty measures to avoid being conned. Sometimes, dishonest employees of insurance companies add to the damage.
Be Well Informed
The process of settling disputes takes time because it is a question of credibility of both the parties that are at stake here. So, if you find yourself having to deal with such a situation, it is best to keep faith and consult the experienced professionals to be through with this matter. Being very thorough with the policy rules before you sign the papers, is most crucial to be on guard should there be any such uncomfortable financial issue.
In addition, continuously updating yourself with the current information about the market share of insurance companies will give you an edge and let you see through any miscommunication that might ensue. It is best to go with reputed, trusted insurance companies while buying insurances rather than investing in comparatively less prominent insurance companies.
buying an insurance plan
disputes regarding insurance matters
issues related to claims
approach the Ombudsperson
delay in processing the claim
non-provision of policy documents
Grievance Redressal Officers
private insurance companies have lower claim settlement percentage
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