₹299/- Online Application for Insurance Dispute Samadhan - Insurance Complaints, Life Insurance, Health and General Insurance complaints, IRDA complaints and Insurance Ombudsman
Indian insurance market, whether General or Health or Life insurance, is full of crook and wicked Insurance Agents who are ready to pounce on unaware clients and defraud not only their money but also their financial goals and plans. There are two broad categories of Insurance in India – Life Insurance and General Insurance.
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Types of Insurance policies
A policy purchased for cover on life is Life Insurance policy. All the Savings policies, Children policies, Endowment, ULIPS, Term and Pension policies etc. come under this category. Term insurance policies have become very popular these days as one has to pay very low premium for Sum assured of 25 lakhs, 50 lakhs or even few crores. A customer may have invested in a Life insurance policy dreaming that it will help him when his children are grown up or help him when he becomes retired but years later comes to know that those goals cannot be met or the returns generated are far less than those promised. There may also be cases where all the Terms and conditions have not been disclosed to him. In case of Term insurance plan, if a customer dies within 3 years of buying the policy then claim may be rejected or delayed on grounds of ‘early death case’.
Policies bought to cover damage to Car, Bike, Health, Household items, Factory assets, Marine insurance etc fall under category of General Insurance. A customer may have availed a Health insurance policy with great hopes that it will help him in unexpected times of health issues. He may come to know that policy terms are such that several diseases do not get covered till the time policy is 3 years or 4 years old. In worst case insurance company may not honour the claims altogether all for fictitious reasons.
In case of car/bike insurance too there have been cases of non-honouring of genuine damage claims. One buys zero depreciation policy and then come to realise that 50% deduction has been done on claim for plastic parts. In some cases, car catches fire and insurance company reject the claim on flimsy grounds that it did not happen naturally.
There are different authorities which you need to approach as per your case. In case of dispute, the first and foremost thing is to approach customer care call centre, if not satisfied then you have the options to reach out to Grievance cell, Insurance ombudsman and Consumer court. You also can reach out to Insurance Regulatory and Development Authority (IRDA).
IRDA has also taken initiatives to improve things. It has launched Integrated Grievance Management System (IGMS) to resolve customers’ issues. However, several times people complain that this system is not working or giving awkward results. Sometimes, customer is indeed able to lodge complaint but it has no effect on working of insurance company and complaint remains unresolved.
Working of Insurance policies:
Basically, insurance policy, whether General or Life, is bought to cover the costs of loss in case of loss of life or property. There are several clauses and riders attached to each policy and understanding them is very important to ensure that you get what you are entitled to in case of loss and simultaneously not expect any thing larger than that. We should be careful enough that Agent/intermediary is not able to fool us by promising returns which we may not be entitled to.
This is the initial stage of availing insurance, we interact with the agent or broker explain our requirements and accordingly some plans are suggested to us. We go through them, try to understand the policy and buy it.
Claim Settlement Ratio:
This is very important term and we should be careful about it. This tells us out of total number of claims filed by customers, how many claims have been passed by that particular insurance company. This ratio is easily available on different websites including that of IRDA. Higher the CSR better it is, these days CSR of 94% or more is considered as good one.
Free look period:
We should be aware that there is 15 days of free look period, it means that once we receive the policy bond, we can go through it carefully and read all the benefits and terms & conditions mentioned in it. If we do not find it as per our expectations then we can surrender the policy and get refund of the money which we have paid.
Payment of premiums:
In case of Life insurance policy - premiums are yearly, half yearly, quarterly and monthly. We need to ensure that premiums are paid on time and policy does not gets lapsed. Many times insurance companies allow some Grace period even after due date of premium payment. We generally find out what is the grace period for policy and delay the payment of premium till the end of grace period. However, it should be noted that once the due date of premium has expired, though there may be Grace period but coverage of policy is not applicable in Grace period. In simple words if something wrong happens during Grace period no sum assured will be payable by the insurance company.
Filing of claims:
In an unfortunate case of loss of life or property, we may need to file claim with the insurance company. We should try to do this at the earliest possible time. Insurance companies may ask to file claim within 24 hours of the incidence but that is ideal situation and not the mandatory one.
Rejection or delay in claim settlement:
In case insurance company is doubtful of claim or the document submitted, it may ask for further explanation of the things. Usually, companies appoint a surveyor or any officer for settlement of claim. It is better to explain things to him with courtesy, there is no need to offer any bribe to him as this may be not only unethical but also counterproductive. If you find there is unjustifiable delay or rejection of the claim, you can always take the Legal course of action.
In case of long-term Life insurance policies (not the Term insurance plans), there is the provision of availing loan against the accumulated balance in the policy account. You check with your insurance company and find out how much amount is accumulated and the amount which you can avail as loan.