If you have made a claim with the insurance company and for some reason your claim is rejected, then you can complain to IRDA.
In the midst of the second wave of corona virus, people had to face many health-related difficulties. Many people got treatment in hospitals and now they are requesting insurance company to take claim. In these, companies are rejecting the claims of many people due to some reasons. If this has happened to you also and you feel that your case is correct and you have fulfilled all the conditions at the right time, then you can also complain to the insurance company.
If you are also not happy with the insurance company and you want to complain to the insurance company, then you can. In such a situation, you can complain to the insurance company from IRDA and even after the complaint, if your case is not heard, then you can also complain to the Insurance Ombudsman. In such a situation, know what is the process and what are the rules regarding the complaint.
What will need to be done?
First of all, put your point in the complaint cell of the insurance company. If you do not get a proper reply within 15 days from there, complain to IRDA. After this, you can complain by e-mail to IRDA’s complaints@irdai.gov.in. If you want, you can also complain on IRDA’s toll free number 155255 or 1800 4254 732. If nothing happens after complaining here, then you can complain to the Insurance Ombudsman.
What is Insurance Ombudsman
The Insurance Ombudsman makes coordination between the insured and the insurance company and can also fix a claim amount on paper basis. If the insured agrees to the claim amount, then the order is passed and the company has to comply with the same within 15 days. The Ombudsman then delivers the decision, which the insurance company has to abide by.
Apart from this, you can file your appeal against the company in the Consumer Commission. There is also a facility to complain online for this. However, later you will have to appear in the consumer court and then every effort will be made to get your justice. However, in this, the people making the claim have to fulfill all the conditions of the insurance company, even after that if the claim is rejected, then you definitely get justice.
Apply for large number of claims
According to the report of the General Insurance Council, till May 14 this year, about 15 lakh applicants have applied for the claim. Out of which claims of 12.35 lakh customers have been settled. According to the report, different health insurance companies have paid about Rs 22,955 crore in settling these claims, which in itself is quite high. According to the data, 14.82 lakh customers have applied for health insurance during the Corona period. In which more than half has been paid by the general insurance companies. An amount of Rs 11,161 crore for health insurance is yet to be paid by 2.5 lakh customers.
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