Relationship manager of a leading private bank had suggested an investment cum insurance product to Vipul, a ULIP policy, which their bank was offering due to their tie up with an insurance company. The Relationship Manager explained Vipul all the policy terms in details. Vipul was very impressed with the RM and bought the product immediately. But when Vipul received the actual policy document, they were different than what was explained earlier. Vipul went to the bank to and found out that the RM, who sold him the product, no longer works in the bank. Other RMs asked him to contact customer care of the bank. Every time he call customer care of the bank, they tell him that nothing can be done now. What should he do now?
Use Free Look Period
The policyholder has 15 days from the date of receipt of the policy to review the terms and conditions of the policy. In case he disagrees to any of the terms and conditions, then he can exercise the option to return the policy, stating the reasons for his objection. In case the policyholder exercises the free look period and returns the policy, the insurance company should refund the premium paid, after deducting the expenses incurred on medical examination and stamp duty charges.
Write to your Insurance Company
If your are being victim of wrong Insurance sale or any other queries related to your insurance product, and already crossed the ‘free look period’ then write to the Insurance company. Provide them all the info with copies of all documentation related to your grievance. In your letter specify, why in your opinion it’s been wrongly sold to you, set a timeline and the next steps you will be taking if you don’t hear from the Insurance company. Please be polite and clear in your message and request the Insurance company to address your grievance in a timely manner. Make sure you send your letter via registered post (with acknowledgement due) to ensure that you have proof that the other party has received your letter.
What all complains you can file with the Insurance Ombudsman
1. Any partial or total repudiation of claims by an insurer
2. Any dispute in regard to premiums paid if payable in terms of the policy
3. Any dispute on the legal construction of the policies in so far as such disputes relate to claims
4. Delay in settlement of claims
5. Non-issue of any insurance document to customers after receipt of premium.
Contact the Insurance Ombudsman in your region
If you won’t receive the reply from the insurance company within stipulate time, please contact the office of Insurance Ombudsman. This is a quick way of addressing consumer grievance, without having to go to court. While the decision of the Ombudsman is binding on the Insurance companies, the consumer still has the option to go to court if the Ombudsman’s decision is not acceptable to them. To find out contact information about the Insurance Ombudsman for your region visit – http://www.lifeinscouncil.org/list-of-insurance-ombudsmen
Whoall can make a complaint with Insurance Ombudsman?
1. Any person who has a grievance against an insurer, may himself or through his legal heirs make a complaint in writing to the Ombudsman within whose jurisdiction the branch or office of the insurer, against whom the complaint is made, is located.
2. The complaint shall be in writing duly signed by the complainant or through his legal heirs and shall state clearly, the name and address of the complainant, the name of the branch or office of the insurer against whom the complaint is made, the fact giving rise to the complaint supported by documents, if any, relied on by the complainant, the nature and extent of the loss caused to the complainant and the relief sought from the Ombudsman.
3. No complaint to the Ombudsman shall lie unless
a) The complainants had, before making a complaint to the Ombudsman, made a written representation to the insurer named in the complaint and either insurer had rejected the complaint or the complainant had not received any reply within a period of one month after the insurer concerned received his representation or the complainant is not satisfied with the reply given to him by the insurer.
b) The complaint is made not later than one year after the insurer had rejected the representation or sent his final reply on the representation of the complainant; and
c) The complaint is not on the same subject matter, for which any proceedings before any court, or Consumer Forum, or arbitrators is pending or were so earlier.
File a case in a Consumer Court
If you are not satisfied with the decision by the Insurance Ombudsman then you still have the option to file a case in the Consumer Court.
Frequently Asked Questions
What all things you need to remember before lodging a complaint with Insurance Ombudsman?
1. First communicate with your insurance company about your grievance and only if the company does not respond within a month or if the reply does not satisfy you, you can lodge the complaint.
2. Lodge a complaint with Ombudsman within a month of the insurance company’s response.
3. You cannot lodge a complaint if the same case is pending before any court, any consumer forum or arbitrator.
Is there any charge for this service?
Policyholder can approach the Insurance Ombudsman for the redressal of their complaints free of cost.
What documents do I need?
Photocopies of all documents related to grievance, any supporting documents from other sources, plus any communication with insurer or any other party related to grievance.