A healthy financial sector is essentialforeconomic growth.The insurance industry is expected to grow toUS$ 280 billion* by FY2020, owing to the solid economic growth and rising personal disposable incomes in the country.
The Insurance Regulatory and Development Authority of India (IRDAI)amended the (Protection of Policyholders’ Interests) Regulations, 2017 to ensure that insurance customer’s interests are better protected.
To ensure that the insured receives the claim from the insurer in a stipulated period, the new rules state the time frame that needs to be followed by the insurance company for a seamless process.
Claim Process for General Insurance Policy:
Upon intimation of a claim from the customer, the insurance company needs to adhere to the following process and timeline:
- Appoint a surveyor within 72hours of claim intimation.
- The surveyor needs toinitiate the survey within 48hours of appointment.
- In the event of clarification or need of additional documentation, the company must contact the claimant within 7days of receipt of documentation.
- An interim report is to be forwarded by the surveyor to the company no later than 15days from the date of first visit.
- In case the claimant has not been able to submit complete documentation, the company needs to inform the customer in writing and follow up regarding the mandatory submission.
- The first survey report needs to be sent by the surveyor to the insurance company within 30days.
- All claims to be settled/rejected by the insurer within 30days of receipt of the final survey.
- In the event the amount admitted is less than the amount claimed, then the insurer should inform the claimant in writing, drawing reference from the specific terms and conditions mentioned in the original policy document.
- In the event the claim is not settled within 30days, the insurer is liable to pay the claimant an interest, which is 2% above the bank rate from the date of receipt of last necessary documents till the date of actual payment.
Claim Process for Health Insurance Policy
The timeline and process to be followed by the insurance company is as:
- The company has to settle the claim within 30days from the date of receipt of final documentation.
- In case of delayed payment, the insurer shall be liable to pay an interest, which is 2% above bank rate from the date of receipt of final documents till the date of actual payment.
If there is a request of return of premium or cancellation of the policy during the Free Look Period, the refund shall be processed and actioned within 15days of the receipt of the request of cancellation.
If the consumer is unhappy with the insurance company then he can address his concerns to the company or the IRDA to resolve the issues.
Grievance Redressal Committee
The IRDAI has a mechanism for registering policy holders’ complaints against insurance companies:
- Approach Grievance Redressal Officer (GRO) of the insurance company. GRO to resolve issue within 15 working days, if still unsatisfied, customer can approach IRDAI.
- Approach the Grievance Redressal Cell of the Consumer Affairs Department of IRDAI.
- If not satisfied with the resolution offered by the insurance company, the complaint can be escalated further to the Insurance Ombudsman, if it falls within the purview of the Ombudsman. IRDAI will help resolve the issue by taking it up with the Insurance Company.
- Fordisputes where enquiry or adjudication is required,customers may approach the Consumer Forum or Courts.
An informed consumer is an empowered consumer. Understanding the need of the hour of empowering the consumer with appropriate knowledge about the system, IRDAI has accorded priority to their education, protection and awareness.
For more details and the complete regulation please Check: http://www.policyholder.gov.in/uploads/CEDocuments/PPHI.pdf &