Alternative Remedies Available For Realizing The Insurance claims

State Insurance Regulator

Taking an insurance company to court should be used as a last resort as it can tie up a claim in court for many years and seriously delay receiving needed funds to replace a home or pay medical bills.

The first steps are to attempt to work directly with your insuranceagentor insurance firm provider in a calm, patient manner – documenting the entire process all the while. If they end up proving difficult to work with, utilizing the services of a state insurance regulator can help move the process forward.

It has seen from most of the cases that instead of taking due diligence or utmost care, rejection of claim still happen.

Few questions are resolved by this article like, options available for policyholder for claiming rejection etc.

Following are the procedure by which the policyholder may seek resolution
1. Approach IRDA, an Insurance Regulatory and Development Authority

2. An Approach to Insurance Ombudsmen under Rule 12 of Redress of Public Grievances 1998.
3. Approach to Alternative Dispute Resolution (ADR), under any specific policy.
4. An Approach to Consumer forum.
5. Approaching the commercial court under section 2(c)(xx) of the Commercial Court ,commercial division & Commercial Appellant Division Act.

IRDA, an Insurance Regulatory and Development Authority (Approach 1)
Before one intensify touch on IRDA, you ought to have:
1. Approached the grievance redressal cell of the underwriter or the Insurance Company. Provided all the supporting documents and brought acknowledgement of the criticism. You’ll be able to additionally drop e-mail to Grievance Redressal Cell of the insurance firm.
2. If the underwriter doesn’t respond and resolve the problem to your satisfaction among fifteen days from the date of criticism, you’ll be able to intensify to IRDA.

How does one step up the pertain IRDA?
You can approach the Grievance Redressal Cell of the patron Affairs Department of IRDA in either of following ways that.
# One Call Toll-Free range 155255 or 1800 4254 723[5]
# Send e-mail to complaints atirda.gov.in
# Register your criticism through Integrated Grievance Management System (IGMS).
# Send a letter or fax (040-6678 9768) to IRDA together with your criticism. One be able to notice the criticism kind and address here.

Insurance Ombudsmen under Rule 12 of Redress of Public Grievances 1998 (Approach 2)
Insurance Ombudsman has power under Section 12(1)(b) in the Redressal of Public Grievances Rules, 1998to act as a counsellor or mediator which are related to any partial or total repudiation of claims by an insurer.[7]

In addition to this, the person in authority shall give in writing about the settlement done between in the policyholder and the insurer.

This is to be noted that the decision made by the Insurance shall be binding and final on both the parties.

Whenever the policyholder wants to approach Insurance Ombudsman, he/she may approach without any layer too. You must approach the Insurance investigator beneath whose jurisdiction the branch or workplace of the underwriter falls.

Consumer forum or a court of law (Approach 3)
Once increase to IRDA or approaching Insurance investigator (in choose cases) one can take the fight to client forum or civil courts.

One can also approach the courts while not approaching IRDA or investigator. However, this is often seemingly to be a long method and not restricted by timelines as in 1st 2 ways.

In the case of Om Prakash v. Reliance General Imsurance[8]is has been held by the honourable supreme court that the insurance company cannot reject claims on Technical Grounds.

End-Notes
[2] http://www.policyholder.gov.in/RPG_Rules_concerning_Ombudsman_scheme.aspx
[3] If there is an arbitration clause.
[4] https://www.prsindia.org/uploads/media/Commercial%20courts/Commercial%20courts%20Act,%202015.pdf
[5] https://www.irdai.gov.in/Defaulthome.aspx?page=H1
[6] http://www.policyholder.gov.in/uploads/CEDocuments/complaintform.pdf
[7] Consumer Education Website, Address of Ombudsmen available athttp://www.policyholder.gov.in/Addresses_of_Ombudsmen.aspx
[8] MANU/SC/1259/2017

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