GRIEVANCE CELL-CAD

FAQs

Insurance Regulatory and Development Authority (IRDA) was set up as an autonomous body under the IRDA Act, 1999 to protect the interests of policyholders and to regulate, promote and ensure orderly growth of the insurance industry. Redress of grievances is one of the key components of IRDAI’s efforts in protection of interests of proposers and policyholders.

Please approach Grievance Redressal Officer (GRO) of insurance company whose contact details are available in policy document/Insurance company website. Complaint is to be given in writing along with the necessary support documents.

In case there is no response from insurance company or the resolution provided is not to the satisfaction of the complainant, he/she can escalate his complaint to IRDAI. IRDAI will take it up with the insurance company concerned and shall facilitate re-examination of the complaint so as to provide final resolution by the Insurance company.

A complaint can be registered with IRDAI through any of the following modes

1. Calling Toll Free Number 155255/1800 425 4732 (i.e. IRDAI Grievance call Centre) or

2.Sending an e -mail to complaints@irda.gov.in

3. Registering a complaint on Integrated Grievance Management System at www.igms.irda.gov.in

4.Fill and send the Complaint Registration Form available in the IRDAI web site www.irdai.gov.in along with any letter or enclosures, if felt necessary, and send by post or courier to:

The Chief General Manager,

Consumer Affairs Department - Grievance Redressal Cell,

Insurance Regulatory and Development Authority of India (IRDAI)

4th Floor, Sy No. 115/1, Financial District,

Nanakramguda,Gachibowli,

Hyderabad – 500032

IRDAI Grievance Call Centre(IGCC) was launched on July 20,2010 as an alternative channel for prospects and policy holders with comprehensive tele functionalities. The call centre serves as a toll free, 12 hours X 6 days service platform, from 8 AM to 8 PM, Monday to Saturday.The services are offered in not only in English and Hindi but also in other major Indian languages It is an inexpensive, expeditious and simple method of registering complaints, ascertaining their status and escalating them to IRDAI. The toll free number of the call centre is 155255/1800 425 4732 and can be contacted to register a complaint against Insurance company and track its status.

IRDAI launched the Integrated Grievance Management System (IGMS) in April 2011. IGMS is a comprehensive solution that provides a centralized and online access to the proposer or policyholder to register and track complaints. Apart from creating a central repository of industry wide insurance grievance data, IGMS is a grievance redress monitoring tool for IRDAI.

Proposers or Policyholders who have grievances should register their complaints with the Grievance Redress Channel of the Insurance Company first. If they are not able to access the insurance company directly for any reason, IGMS provides a gateway to register complaints with insurance companies and track their status. A complaint registered through IGMS will flow to the insurance company’s system as well as the IRDAI repository. Updating of status will be mirrored in the IRDAI system.

The Insurance sector’s grievance redressal system has been explained in detail in a handbook published by IRDAI and the scanned copy of the same can be accessed at www.policyholder.gov.in/Grievance_Redressal_System.aspx

The status of the grievance registered in IGMS can be tracked by calling toll free number or by accessing igms.irda.gov.in.

IRDAI takes action against Insurance companies as per Insurance act and relevant regulations. Please ‘refer warnings and penalties’ section displayed in Home page of IRDAI website (www.irdai.gov.in).

IRDAI does not adjudicate on individual policyholder complaints. IRDAI facilitates the re-examination of the grievance so as to provide resolution by Insurance company. In case the complainant is not satisfied with the resolution of the insurance company, he/she may approach the Insurance Ombudsman or the appropriate judicial forum.

No, resolution of any grievance does not fall under the purview of RTI Act, 2005.

Please refer ‘consumer affairs booklet’ section by visiting IRDAI website www.irdai.gov.in Home>>Grievances>>Consumer affairs. You may also access the same through following link https://www.irdai.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo3189

Annual report / Handbook

IRDAI does not involve in the operational procedures of the Insurance companies. Please contact the concerned Insurance company in this regard.

IRDAI does not collect individual insurance policy/claim level information from insurance companies. Please contact the concerned Insurance company in this regard.

Grievance/compliant has been specifically defined in Regulation 4(4) of the Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests) regulations, 2017 which reads as follows:

“Complaint” or “Grievance” means written expression (includes communication in the form of electronic mail or other electronic scripts),of dissatisfaction by a complainant with insurer, distribution channels, intermediaries, insurance intermediaries or other regulated entities about an action or lack of action about the standard of service or deficiency of service of such insurer, distribution channels, intermediaries, insurance intermediaries or other regulated entities;

Explanation: An inquiry or request would not fall within the definition of the “complaint” or “grievance”.

Yes. The IRDAI has mandated insurers to have in place a board approved policy which shall contain among other matters, the matter pertaining to service parameters including turnaround times for various services rendered.

Every insurer shall display the service parameters and turnaround times as approved by the Board in its website and keep the same updated as and when the service parameters are revised by the Board.

Please refer Regulation 8(6) of Protection of Policy Holders’ Interest (PPHI) (Regulations) 2017.

The insurer shall process the proposals and communicate its decision on proposal in writing to proposer within 15 days from date of receipt of proposal or any requirements called for by insurer.

Please refer the policy document for the terms and conditions. Also as per IRDAI PPHI regulations 2017, every insurer shall place in its website the terms and conditions of every insurance product that is offered for sale by the insurer as it was approved by the Authority under File and Use procedure or filed with the Authority under Use and File procedure, including products modified or products withdrawn. The UIN allotted by the Authority to every insurance product shall also be mentioned against each product.

The insurer shall process the proposals and communicate its decision on proposal in writing to proposer within 15 days from date of receipt of proposal or any requirements called for by insurer.

On receipt of the policy document, the policyholder can review terms and conditions of the policy and if it is not agreeable, then the policy can be cancelled within 15 days from date of receipt of policy document and period of 30 days in case of electronic policies and policies obtained through distance mode. Please refer Regulation 10 of Protection of Policy Holders’ Interest (PPHI) (Regulations) 2017 in this regard. You may also refer the same by accessing the following link: https://www.irdai.gov.in/ADMINCMS/cms/frmGeneral_Layout.aspx?page=PageNo3191&flag=1

Please refer Regulation 14,15 and 16 of Protection of Policy Holders’ Interest (PPHI) (Regulations) 2017 for matters to be stated in Life, General and Health Insurance policy respectively. You may refer the same by accessing the following link: https://www.irdai.gov.in/ADMINCMS/cms/frmGeneral_Layout.aspx?page=PageNo3191&flag=1