Facing a problem with your insurance service provider?

Well, we will help you out by sending a legal notice and then file a consumer complaint, if necessary.

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What is Insurance?

Insurance is an assurance that a sum of money will be paid to the person insured if a particular event occurs. There are different types of Insurance.

Example:

Life insurance is a contract between you and a life insurance company. You agree to pay for the policy on a regular basis, and the insurer agrees to pay a sum of money to the beneficiaries on the policy holder's death. Within those parameters are several types of life insurance.

General insurance or non-life insurance policies, including automobile and homeowners policies, provide payments depending on the loss from a particular financial event. General insurance is typically defined as any insurance that is not determined to be life insurance.

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What are insurance Consumer Complaints?

A policy holder or an insured or any person who acts as a nominee or a trustee of the beneficiary are called the Consumer of an Insurance. If a consumer faces any issue with the payment or disbursement of the insured amount and for various other reasons as enumerated below, then a complaint can be raised which is called an Insurance Consumer Complain


Who can file consumer complaints in the insurance sector?

Policyholders or beneficiaries or on behalf of either of them can file their grievance.


When can I file an insurance consumer complaint?

  • Policy issues
  • Policy maturity issues
  • False commitments
  • Fake insurance policy Complaints.

Policy issues:

Issues related to the initial stage itself like a false representation of benefits or terms and conditions are not the same as explained by agents or intermediaries.

Policy maturity issues:

During the claiming stage, the claimant faces so many legal issues because of deduction of insurance claims or refusing on false allegations.

False commitments:

The false commitment was given by agent \ intermediaries \ insurance company which leads to present compensation issues or claiming beneficiary issues.

Fake insurance policy Complaints:

In this fraudulent insurance company\ fraud agents who represented themselves as some other company or which existed in the market and collected some of the amounts as premium from the common public by deceiving benefits which were totally fake.

Where to file the consumer complaint?


First step: Written Complaint

You need to send a written complaint to the insurer’s grievance redressal officer by attaching the relevant documents. Their contact details are available on the policy document as well on the web sites of the insurer.

The written complaint should contain:

  • All the facts with relevant details like dates, times and amounts - this is often a legal record of your dissatisfaction so state everything that went on thus far .
  • Any complaint and/ or reference numbers.
  • Names of the representatives of the Seller that you have been interacting with.
  • Maintain courtesy and politeness at all times.
  • State the amount of your claim clearly.
  • Provide at least 15 days for the other party to reply to your notice.
  • State that you simply will approach the buyer Forum if your issue isn't resolved.
  • Address the Notice to the correct party/parties.
  • Send the notice through a registered post and record the acknowledgment of receipt.

In the written complaint, you should not:

  • Use foul language.
  • State anything which is factually incorrect.
  • Use threatening language.
  • Be vague about the amount you want to claim.
  • Forget to mention the reference/ invoice/ complaint numbers.
  • Demand excessive compensation - it's important to be realistic and obtain a speedy resolution.

For claims over Rs. 10,000, it is highly recommended that you consult a lawyer and send the notice through the lawyer, with the official letterhead. This will indicate to the seller that you are serious about taking legal action.

Second step:

The insurance company is then required to address the issue within 15 days. Please wait for their reply this time.

Third step:

If they don’t, you can lodge a complaint with the Insurance Regulatory Authority of India (IRDA) customer care number: 155255 or 1800 4254 732 and their Email ID is complaints@irda.gov.in or you can fill the form directly which is available on their website.

Final step:

Still, if you don't get a proper response about the action or lack of action taken you can approach the insurance ombudsman or file a consumer complaint.

  • Delay in claim settlement, beyond the time specified in the regulations, framed under the IRDA Act, 1999.
  • Any partial or total repudiation of claims by the insurer.
  • Any dispute about premium paid or payable in terms of the insurance policy.
  • Misrepresentation of policy terms and conditions at any time in the policy document or policy contract which affects policyholders highly.
  • Policy servicing related grievances against insurers \ their agents \ intermediaries\ all of them.
  • Issuance of life insurance policy, a general insurance policy that is not in conformity with the proposal form submitted by the proposer.
  • Non Issuance of insurance policy after receipt of premium in life insurance and general insurance.
  • Any other matter resulting from the violation of provisions of the Insurance Act, 1938 or the regulations, circulars, guidelines or instructions issued by the IRDA from time to time or the terms and conditions of the policy contract.

The settlement process

The Ombudsman acts as a mediator and arrives at a fair recommendation based on the facts of the dispute. If you accept this as a full and final settlement, the Ombudsman will inform the corporation which should suit the terms in 15 days. If a settlement by recommendation does not work, the Ombudsman will Pass an award within 3 months of receiving all the requirements from the complainer and which will be binding on the insurance company.

FAQs

To get the best result and avoid risking the entire claim, it is best to hire a lawyer. This is especially true in cases where the value is high or where the complaint is of a very serious nature. Consumer lawyers are experienced in handling these cases and know how to file complaints in court, so they can help you put together a tight case against the offender.
Depending upon the response of the service provider it usually takes 8 to 18 months. In matters that are contentious, it could take a bit longer. Sometimes an out of court settlement is also possible, in which case issues can be resolved much faster.
There is no such fixed value that is to be claimed. However, depending upon the value a reasonable amount could be claimed provided that reasonable documentation must be provided.
Legal notice is simply the requirement that a party must be furnished with sufficient knowledge concerning the legal processes that affect his rights and duties or obligations.
It is a way of notifying individuals or organizations about a matter by using a method required by the law courts.
Legal Notice is the formal communication to a person or entity informing him that we intend to undertake legal proceedings against him. It is a step taken before filing a suit and is meant to warn the other party that legal action may be taken against him.
If a product or service is free or purchased for commercial purposes, then you cannot approach the Consumer Court, hence not considered as a consumer.
If you don't respond to the legal notice, then most likely the person will eventually file a defamation suit in the Court. Once the defamation suit is filed in the Court, the Court will send you a summons to appear and answer the charge pressed by the opposite party.
The court expects you to try and resolve the dispute before approaching them. Hence, the legal notice serves as proof of this. The notice is given to the concerned party and then there is a waiting period of 15 days before filing a complaint with the Consumer Forum.

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