Advisories on Insurance Sector

Insurance Policies - Discharge your Responsibilities and Assert your Rights

When you buy a policy

• Fill the proposal form yourself correctly and truthfully, it is the basis of the insurance contract
• Do not leave any column blank, do not sign a blank proposal form
• You will be responsible for any information in this document as it bears your signature. Disclose “all material information” about the risk you want to cover
• Select the term of the policy as per your needs
• Select the amount of premium you can afford to pay
• Choose between Single Premium or Regular Premium
• Choose your premium paying frequency such as annual, half - yearly, quarterly or monthly
• Opt for electronic payment of your premium (ECS) for your convenience, safety and records
• Ensure to register nomination under your policy. Fill the nominee’s name correctly

After you submit the proposal form

• Once the proposal is submitted, you should hear from the insurance company in 15 days
• If not, take up the matter in writing
• If any additional documents are asked for, comply immediately
• Once the proposal is accepted by the insurance company, the policy bond should reach you within a reasonable amount of time i f not, contact the insurance company about it
• When policy bond is received, check it and be sure that the policy is the one that you wanted.
• Go through all the policy conditions and be sure that these are the same that were explained to you by the intermediary/ insurance company official at the time of sale
• In case of doubts, contact the intermediary/ insurance company official immediately for clarification.
• If necessary contact the insurance company directly

Maintaining the policy

• Pay your premium regularly on the due dates/ within the grace period
• Do not wait for a premium notice. It is only a courtesy. It is your duty to pay the premium to avoid lapsation or other penal ties
• Do not wait for your intermediary or anyone to pick up your cheque. Make your own arrangement for paying the premium on time
• If there is a change of address, please intimate the insurance company immediately.

Nomination

After the policy is issued, you can change the nomination by:

• Filling a notice of change of nomination and
• Sending them to the insurance company for them to register it in their records
• If the nominee is a minor, appoint an appointee to receive any claim paid while the nominee is still a minor
• Get the appointee to sign in the endorsement showing consent to act as an appointee

If your policy lapses

• If you fail to pay the premium in time, your policy may lapse. Contact the insurance company for reviving it.

If you lose your policy

• If you lose your policy bond, report it to the insurance company immediately
• Get a duplicate policy by complying with the formalities
• The duplicate policy confers the same rights as the original policy bond

At the time of a claim

• Comply with all the requirements of the insurance company
• Whenever required, you should help the insurer in a prosecution or for recovery of claims which the insurer has against third parties You have the right to
• Cancel the policy within 15 days from the date of receipt of the policy document. If you disagree to any of the terms or conditions in the policy
• You can
• Return the policy stating the reasons for objection
• You will be entitled to a refund of the premium paid
• A proportionate risk premium for the period on cover and the expenses incurred by the insurer on medical examination and stamp duty charges will be deducted If it is a unit linked insurance policy (ULIP) in addition, the insurer can repurchase the units at the price on the cancellation date.

Complaint Redressal in Insurance Sector

Insurance Regulatory Development Authority (IRDA) has mandated all insurance companies to have an effective grievance handling system which needs to be specified in their policy document. Based on the grievance handling system in Insurance sector:

1. The consumer in case of any complaint is advised to write his complaint by letter/email to the concerned insurance company. All the insurance companies are required to provide contact details of their Grievance Redressal Officer on the policy documents, web - site etc. Click here for contact details of Grievance Redressal Officers, GRO, of all insurance companies. The complaint may be submitted in written form and the acknowledgement obtained. The complaint is required to be redressed within 15 days of the receipt of the complaint.
2. In case of no response within 15 days or un-satisfactory response, the consumer is advised to escalate the complaint through IRDA grievance Redressal cell through their toll free number 155255 or through email complaints@irda.gov.in or through Integrated Grievance Management System (IGMS) of IRDA deployed at www.igms.irda.gov.in. IRDA normally forwards the complaint to the concerned insurance company. The complaint if being sent by letter or fax, may be sent to
   Consumer Affairs Department,
   Insurance Regulatory and Development Authority,
   3-5-817/818, United India Towers, 9th floor, Hyderguda, Basheerbagh,
   Hyderabad – 500 029,
   Fax no. 040 - 66789768.

The Complaint registration process through IGMS involves the following TWO SIMPLE steps

• Step 1 : Register yourself by entering your details
• Step 2 : Register your complaint and view its status
• In case the consumer still does not get any response within 30 days of the complaint or gets un-satisfactory response, the consumer may approach Insurance Ombudsman as per stipulated jurisdiction. The award of Insurance Ombudsman is to be complied by Insurance Company within 15 days. However, the Insurance Ombudsman cannot take cases where the value of claims exceeds Rs. 20 lakhs. The Ombudsman shall pass an award within three months of receipts of the complaint and the award is binding on the insurance Company. The time limitation for filing a complaint with Insurance Ombudsman is one year from the date of which either the insurer is responded or should have responded after receipt of the complaint.
• In case the consumer still feels aggrieved from the awards of Insurance Ombudsman, the consumer can file a case with District Consumer Forum or if the value of claim exceeds Rs. 20 Lakhs, the consumer can file a case with State Consumer Redressal Commission.

Source : State Consumer Helpline Knowledge Portal

Related resources

1. FAQs on Insurance
2. How to make a claim