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Stress on consumer awareness for redressal of insurance-related grievances

By STAFF REPORTER

GUWAHATI, Nov 18 - The office of the Guwahati Insurance Ombudsman observed the Insurance Ombudsman Day (Bima Lokpal Divas) recently with a daylong programme.

The meeting held on the occasion stressed the need for awareness among the consumers for redresasal of their insurance-related grievances.

The day was marked by distribution of leaflets among the public and a seminar on the need and importance of Insurance Ombudsman awareness among the insured population.

On the occasion, Ombudsman KB Saha gave an account of the history and functioning of the Ombudsman office and how aggrieved consumers could redress their insurance-related grievances through appropriate procedures.

The Insurance Ombudsman scheme was created by the Government of India for individual policy holders to have their complaints settled out of the courts system in a cost-effective, efficient and impartial way.

Saha said that there are at present 17 Insurance Ombudsman in the country and any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee, make a complaint in writing to the Insurance Ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential address or place of residence of the complainant is located.

One can approach the Ombudsman with complaint if one has first approached one�s insurance company with the complaint and they have rejected it or not resolved it to one�s satisfaction or not responded to it at all for 30 days, or one�s complaint pertains to any policy one has taken in one�s capacity as an individual and the value of the claim including expenses claimed is not above Rs 30 lakh.

Saha also urged the consumers from the North East to avail free services from the Ombudsman.

One can complain to the Ombudsman about delay in settlement of claims beyond the time specified in the regulations, framed under the IRDAI Act, 1999, about any partial or total repudiation of claims by the life insurer, general insurer or the health insurer, any dispute about premium paid or payable in terms of insurance policy, any misrepresentation of policy terms and conditions at any time in the policy document or policy contract, any legal construction of insurance policies in so far as the dispute relates to claim, any policy servicing-related grievances against insurers and their agents and intermediaries, and any issuance of life insurance policy, general insurance policy including health insurance policy which is not in conformity with the proposal form submitted by the proposer.

Further, complaints can also be about issuance of insurance policy after receipt of premium in life insurance and general insurance including health insurance and any other matter resulting from the violation of provisions of the Insurance Act, 1938 or the regulations, circulars, guidelines or instructions issued by the IRDAI from time to time or the terms and conditions of the policy contract.

Saha said that the Ombudsman would act as a mediator and arrive at a fair recommendation based on the facts of the dispute.

�If a settlement by recommendation does not work, the Ombudsman will pass an award within three months of receiving all the requirements from the complainant and which will be binding on the insurance company,� Saha said.

Once the award is passed, the insurer shall comply with the award within 30 days of the receipt of award and intimate the compliance of the same to the Ombudsman.

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Stress on consumer awareness for redressal of insurance-related grievances

GUWAHATI, Nov 18 - The office of the Guwahati Insurance Ombudsman observed the Insurance Ombudsman Day (Bima Lokpal Divas) recently with a daylong programme.

The meeting held on the occasion stressed the need for awareness among the consumers for redresasal of their insurance-related grievances.

The day was marked by distribution of leaflets among the public and a seminar on the need and importance of Insurance Ombudsman awareness among the insured population.

On the occasion, Ombudsman KB Saha gave an account of the history and functioning of the Ombudsman office and how aggrieved consumers could redress their insurance-related grievances through appropriate procedures.

The Insurance Ombudsman scheme was created by the Government of India for individual policy holders to have their complaints settled out of the courts system in a cost-effective, efficient and impartial way.

Saha said that there are at present 17 Insurance Ombudsman in the country and any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee, make a complaint in writing to the Insurance Ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential address or place of residence of the complainant is located.

One can approach the Ombudsman with complaint if one has first approached one�s insurance company with the complaint and they have rejected it or not resolved it to one�s satisfaction or not responded to it at all for 30 days, or one�s complaint pertains to any policy one has taken in one�s capacity as an individual and the value of the claim including expenses claimed is not above Rs 30 lakh.

Saha also urged the consumers from the North East to avail free services from the Ombudsman.

One can complain to the Ombudsman about delay in settlement of claims beyond the time specified in the regulations, framed under the IRDAI Act, 1999, about any partial or total repudiation of claims by the life insurer, general insurer or the health insurer, any dispute about premium paid or payable in terms of insurance policy, any misrepresentation of policy terms and conditions at any time in the policy document or policy contract, any legal construction of insurance policies in so far as the dispute relates to claim, any policy servicing-related grievances against insurers and their agents and intermediaries, and any issuance of life insurance policy, general insurance policy including health insurance policy which is not in conformity with the proposal form submitted by the proposer.

Further, complaints can also be about issuance of insurance policy after receipt of premium in life insurance and general insurance including health insurance and any other matter resulting from the violation of provisions of the Insurance Act, 1938 or the regulations, circulars, guidelines or instructions issued by the IRDAI from time to time or the terms and conditions of the policy contract.

Saha said that the Ombudsman would act as a mediator and arrive at a fair recommendation based on the facts of the dispute.

�If a settlement by recommendation does not work, the Ombudsman will pass an award within three months of receiving all the requirements from the complainant and which will be binding on the insurance company,� Saha said.

Once the award is passed, the insurer shall comply with the award within 30 days of the receipt of award and intimate the compliance of the same to the Ombudsman.

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