What to do if you have an issue with the claim settlement?

Identify if you have an issue with your claim

Remember,

  • The insurance company must settle your claim within 30 days from when you submit all the documents.

 

  • The company can take a maximum of 90 days in some cases where there is a delay.

If this is not the case, find how you can take action by following the steps given below-

Write a Complaint Letter

Write a Complaint Letter

Write a complaint letter to the manager of your Insurance company. You can either hand over the letter by visiting the branch office or send it through post.

Check out the sample below, you can use it for reference.

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    What to do if even after giving the complaint letter the insurance company does not address your issue?

Go to an Insurance Ombudsman

Go to an Insurance Ombudsman

An Insurance Ombudsman is a third party who can help solve your issues. Go to them after 60 days of submitting your Claim Intimation.

Contact details for some Insurance Ombudsmen can be found in this link.

Find one in your area.

If your issue is not resolved at the Ombudsman stage, you can contact the IRDAI.

Register a complaint with the IRDAI

Register a complaint with the IRDAI

You can do this in two ways

Call on their toll free number: 155255 (or) 1800 4254 732  OR

Register complaint on CPGRAMS portal

For registering a complaint on the CPGRAMS portal, follow the steps given below:

  1. Sign up on CPGRAM portal as a new user using this link.
  2. You will receive a link on your email.
  3. Open the link and you will be redirected to your account
  4. Lodge a complaint related to Insurance and track the status of action taken on complaint via this portal

Two more ways of writing to the IRDAI are

Two more ways of writing to the IRDAI are

Send an email to [email protected]. In the email, include:

  • Policy Number

 

  • Name of Insured

 

  • Details of the claim (Date of death, place, etc)

 

  • Mention what your issue with the Insurance Company is

 

  • Name and Identity Proof of the person making the claim

 

OR

Instead of an email, you can send a grievance letter with the same information to the General Manager of IRDAI. Send it to this address:

General Manager

Consumer Affairs Department- Grievance Redressal Cell

Insurance Regulatory and Development Authority of India(IRDAI)

Sy.No.115/1, Financial District, Nanakramguda,

Gachibowli, Hyderabad-500032

Use this model grievance letter, simply fill in your details and send.

Remember that along with the letter you also have to fill and send complaint registration form

Pro tip:

You can track your complaint through IRDAI’s Integrated Grievance Management System: igms.irda.gov.in

Wondering what to do if all the above options fail to solve your issue?

There is one more option you can use.

File a Legal Complaint

File a Legal Complaint

Appeal to the judiciary and file a legal complaint against your insurance company.

If the insurance company does not abide by the claim settlement rules, you can file a legal complaint against the company.

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    Points to remember

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    The insurance company must settle your claim within 30 days. There can be a delay of a maximum of 90 days.

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    If the company takes longer than this to settle your claim or if you are not satisfied with how much money they pay, you can take some actions.

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    Follow the steps in this chapter to address your issues with claim settlement.

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