Facing insurance issues? Here’s how to file a complaint with the Ombudsman
1 month, 3 weeks ago

Facing insurance issues? Here’s how to file a complaint with the Ombudsman

Live Mint  

Insurance grievances can be frustrating, especially when your claim is rejected, delayed, or unresolved. Any person with a grievance against an insurer can file a written complaint, either personally or through their legal heirs, nominee, or assignee, to the insurance Ombudsman. Step 2: Approach IRDAI’s grievance redressal cell If you are dissatisfied with the insurer’s response, contact the Insurance Regulatory and Development Authority of India : How to file a complaint: Use the Bima Bharosa System on IRDAI’s website, call 1800 4254 732 or 155255, or email complaints@irdai.gov.in. Conditions to approach the ombudsman: You’ve already filed a complaint with the insurer and either: Your claim was rejected, or you did not receive a satisfactory resolution within 30 days. The insurance Ombudsman provides a platform for individual policyholders to resolve grievances against insurance companies efficiently and without court intervention.

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Health insurance claims: How to ensure fair grievance redressal
2 months, 1 week ago

Health insurance claims: How to ensure fair grievance redressal

Live Mint  

My health insurance company has rejected my claim because I am unable to furnish internal hospital papers. —Name withheld on request If your insurance claim has been rejected due to lack of documentation, it’s essential to understand your rights under the latest guidelines from the Insurance Regulatory and Development Authority of India. Insurers must assist policyholders in identifying missing documents …

How to ensure fair grievance redressal for health insurance claims? Know here
2 months, 2 weeks ago

How to ensure fair grievance redressal for health insurance claims? Know here

India TV News  

Being denied a health insurance claim due to lack of documentation can be frustrating, but recent guidelines from the Insurance Regulatory and Development Authority of India aim to address the issue. Simplified documentation Insurers must provide a standardised review of documentation requirements at the time the policy is issued. Written explanation of rejections If the claim is denied, insurers must …

Two insurers rejected her father's death claims. She took them on and won ₹26 lakh.
2 months, 3 weeks ago

Two insurers rejected her father's death claims. She took them on and won ₹26 lakh.

Live Mint  

Delhi resident Gyan Chand and his wife Mahadevi bought a flat worth ₹50 lakh in Noida in 2017. Ambesh emailed the insurance company several times to get the claim under the group accident policy, but it was rejected. "I got hold of the insurance document and the bank statement showed that the bank would deduct ₹200 every year for the …

The US’ angst over health insurance: Lessons for India
2 months, 3 weeks ago

The US’ angst over health insurance: Lessons for India

Live Mint  

The recent murder of the head of a prominent health insurer in the US, allegedly fuelled by resentment toward the industry's practices, has cast a harsh spotlight on claims policies that have left many policyholders dissatisfied. In 2021-22, health insurance surpassed motor insurance to become the largest segment by premiums among Indian non-life insurers. For instance, Star Health, the second-largest …

Insurance ombudsman doesn't allow third party help: A dilemma for policyholders
3 months ago

Insurance ombudsman doesn't allow third party help: A dilemma for policyholders

Live Mint  

When businessman Mukesh Garg’s two insurance claims were rejected, he represented himself before the insurance ombudsman, a statutory body that helps in out-of-court settlement of insurance cases, but sought help from a third party for the required paperwork. Consumer policy expert Bejon Misra, who was a member of the insurance ombudsman advisory committee, highlighted the lack of a level playing …

"Cannot Force Citizens To Run From Pillar To Post": Bombay HC Slaps ₹1 Lakh Cost On Insurance Company For Circumventing Ombudsman's Order
3 months, 1 week ago

"Cannot Force Citizens To Run From Pillar To Post": Bombay HC Slaps ₹1 Lakh Cost On Insurance Company For Circumventing Ombudsman's Order

Live Law  

The Bombay High Court on Monday, while slapping exemplary costs of Rs 1 lakh on an insurance company, ordered the Insurance Regulatory and Development Authority and the Ministry of Finance to consider coming up with a mechanism to keep a check on insurance companies as to whether they are complying with the orders of the Insurance Ombudsman.A division bench of …

Burden of Proof On Insurer To Substantiate Reasons For Denial Of Claim : Telangana State Commission Holds LIC Liable For Deficiency In Service
3 months, 2 weeks ago

Burden of Proof On Insurer To Substantiate Reasons For Denial Of Claim : Telangana State Commission Holds LIC Liable For Deficiency In Service

Live Law  

The Telangana State Commission, presided by Smt. V. V. Seshubabu held Life Insurance Corporation liable for deficiency in service and held that the burden of proof to prove the basis for the repudiation of claim lies with the insurer. Brief Facts of the Case The complainant's deceased husband had a life insurance policy worth Rs. Observations by the State Commission …

Kerala consumer rights panel holds insurance company, bank accountable for medical claim denial
1 year, 1 month ago

Kerala consumer rights panel holds insurance company, bank accountable for medical claim denial

The Hindu  

In a major verdict, the Ernakulam Consumer Disputes Redressal Commission in Kerala has held a general insurance company and a bank that facilitated insurance coverage accountable for denial of medical insurance claim to a customer and directed them to pay a compensation of ₹2.23 lakh. Binu and members V. Ramachandran and Sreevidhia T.N., issued the verdict on a petition filed …

10 things to know about Reserve Bank of India's Integrated Ombudsman Scheme
1 year, 8 months ago

10 things to know about Reserve Bank of India's Integrated Ombudsman Scheme

Firstpost  

The Reserve Bank of India launched a scheme to provide a simple and effective way for customers of various financial services to resolve their complaints. The Scheme integrates the existing three Ombudsman schemes of RBI namely, the Banking Ombudsman Scheme, 2006; the Ombudsman Scheme for Non-Banking Financial Companies, 2018; and the Ombudsman Scheme for Digital Transactions, 2019. The Scheme adopts …

92-yr-old Chandigarh man wins legal fight against wrongly rejected mediclaim
1 year, 10 months ago

92-yr-old Chandigarh man wins legal fight against wrongly rejected mediclaim

Hindustan Times  

Wrongly rejecting a 92-year-old man’s medical claim has cost an insurance firm dear. The 92-year-old alleged that despite the fact that the claim was fully covered as per the terms and conditions of the policy, the company wrongly repudiated it, which amounted to deficiency in service and unfair trade practice. Holding New India Assurance Co. Limited, Chandigarh, guilty of unfair …

Insurance Claim: Three methods to help you resolve insurance-related issues faster; check details
2 years, 3 months ago

Insurance Claim: Three methods to help you resolve insurance-related issues faster; check details

Firstpost  

Insurance coverages are common among individuals who want to ensure financial security for emergency situations. Policyholder objections are regularly sent to the insurance company, but sometimes the customers don’t receive any desired response from the company officials. Here are some additional methods to resolve insurance policy-related issues: Contact the Grievance Redressal Officer: Every insurance company assigns a Grievance Redressal Officer …

Insurance Ombudsman holds meet on Bima Lokpal Day
2 years, 4 months ago

Insurance Ombudsman holds meet on Bima Lokpal Day

Deccan Chronicle  

Hyderabad: The insurance ombudsman, Hyderabad conducted a meeting at the Zonal Training Centre, LIC, Hyderabad on November 11 to mark Bima Lokpal Day. Insurance Regulatory and Development Authority chairman Debashish Panda addressed the participants through an online webcast. He spoke about the major changes taking place in the insurance industry and emphasised that the insurers should strive to achieve the …

Insurance Ombudsman Performs Quasi-Judicial Functions While Deciding Complaints; Award Can Be Challenged Under Article 227: Bombay High Court
2 years, 7 months ago

Insurance Ombudsman Performs Quasi-Judicial Functions While Deciding Complaints; Award Can Be Challenged Under Article 227: Bombay High Court

Live Law  

Observing that the Insurance Ombudsman is like a tribunal while deciding a complaint, the Bombay High Court on Thursday held that an insurance company can challenge Insurance Ombudsman's award before the High Court under Article 227 of the Constitution. The court was dealing with petition under Article 227 filed by an insurance company challenging Insurance Ombudsman decision granting relief to …

Insurance firms to comply with mental health Act: HC
3 years, 11 months ago

Insurance firms to comply with mental health Act: HC

The Hindu  

The Delhi High Court on Monday said that insurance companies are liable to give effect to the Mental Healthcare Act 2017 in their policies from the time it came into force in 2018. The High Court’s directions came on a woman’s plea whose claim for reimbursement of costs for treatment of schizophrenia were rejected by the National Insurance Company Ltd …

Ombudsmen are underutilized in insurance sector
4 years, 2 months ago

Ombudsmen are underutilized in insurance sector

Live Mint  

The ombudsman is a good but under-utilized and misunderstood grievance redressal option for insurance. The ombudsman accepts complaints pertaining to individual or group insurance and can award up to ₹30 lakh. Only in two of 17 ombudsman offices was the number of decisions favouring insurers higher than those favouring policyholders. Although the complaints are unevenly distributed across the 17 ombudsman …

66% of complaints mutually settled: Banking Ombudsman Report
5 years, 10 months ago

66% of complaints mutually settled: Banking Ombudsman Report

Live Mint  

The Reserve Bank of India has released the annual report of the banking ombudsman for 2017-18. However continuing the trend of the previous year, the Ombudsman rejected nearly half the complaints it received as non maintainable. The Reserve Bank of India set up the Banking Ombudsman Scheme in 2006 to hear complaints by banking customers. Coming back to the annual …

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