I P S Grover, ex-Director of Quality Assurance at Ranbaxy, was looking for investment options post his retirement when an insurance agent told him about a one-time premium payment policy that he claimed would offer better returns than fixed deposits. Grover bought four such policies of Rs 1 lakh premium each. "Later I realised it was not a one-time payment policy. I approached the insurer but they were non-cooperative," Grover said.
Grover then approached Insurance Samadhan, a Delhi-based grievance redressal start-up, which helped him draft formal complaint, communicated on his behalf with the insurance company and managed to get 100 per cent money back.
This is one among 13,000 complaints that the Insurance Samadhan has resolved so far over the last 18 months.
"We don't work on each complaint but only take forward the ones that we know are genuine. On an average we only select three-four cases out of 100," says Deepak Bhuvneshwari Uniyal, co-founder & CEO.
Sharing another fraud case, Shilpa Arora, co-founder and COO of the firm says, once a customer was promised Rs 10 lakh loan if he bought a policy of Rs 1 lakh premium per annum with a period of 10 years. "After that person submitted Rs 1 lakh, the agent kept delaying the policy document. So, the free look period of 15 days got over. Needless to say, the person didn't receive any loan and in fact lost Rs 1 lakh," she says.
Life insurance with free health insurance is another way in which fraudsters are conning people. "The agents claim to represent insurers that have life and general both verticals, so it all seems credible," Arora says.
Insurance Samadhan writes blogs, creates videos and shares those on social media to educate customers to avoid getting duped.
Although there is a standard procedure to make a complaint against an insurer, often in the want of time or lack of knowledge, aggrieved policyholders accept insurance company's rejection of their claim. According to Uniyal, it's important to keep emotions aside and communicate in clear legal terminology with insurance companies.
"When customers talk to them (insurance companies), they speak with emotions. We communicate with them in legal language. Legal articulation helps in putting forth a clear point of view," says Uniyal.
How to file a complaint?
If you have a complaint against an insurer, the first step is to approach the insurer via mail or letter with supporting documents and get an acknowledgment of the same. The insurance company is required to address the complaint within 15 days of its receipt. If it doesn't, or if you are not satisfied with the response, you can lodge a complaint with the insurance regulator IRDAI.
You can either approach IRDAI's grievance redressal cell of the consumer affairs department (complaints@irda. gov.in) or by calling on 155255 (or) 1800 4254 732, or fill in the complaint via IRDAI's integrated grievance management system (IGMS) - igms.irda.gov.in.
As per IRDAI's annual report for financial year 2018-19, IRDA is swamped with customer complaints. Over 2 lakh complaints were filed in 2018-19 compared to 19,83,62 in 2017-18, a jump of 4 per cent or 7,663 complaints.
Notably, even after IRDAI's intervention, if the insurer rejects your claim specifying the reason for it, the insurance regulator treats your complaint as resolved. But, if you are still unsatisfied, you can approach the insurance ombudsman. Ombudsman's word is binding on the insurer. If it still doesn't settle your claim, you can approach a consumer court.
Although the mechanism is available, policyholders find it difficult to use it due to lack of awareness and financial literacy. "Even complaint registration on IGMS or approaching Ombudsman need guidance and hand-holding," says co-founder Shailesh Kumar.
"Insurance companies do have right intentions to resolve cases if those are represented well as per terms of the policy contract. However, complaints are presented emotionally rather objectively. We address this problem by providing end-to-end techno legal support," he adds.
Insurance Samadhan charges Rs 500 registration fee, which is valid for each member of the family. Post the resolution of the complaint, the start-up takes 9 per cent share in the claims amount that has been resolved. "Our success rate is 99 per cent. We manage to resolve 90 per cent cases at the insurance company level. Very few go to ombudsman or consumer court level," says Sanjay Aggarwal, Co-Founder & Legal Expert.
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