Claim procedure in respect of a general insurance policy

1) An insured or the claimant shall give notice to the insurer of any loss arising under contract of insurance at the earliest or within such extended time as may be allowed by the insurer. On receipt of such a communication, a general insurer shall respond immediately and give clear indication to the insured on the procedures that he should follow. In cases where a surveyor has to be appointed for assessing a loss/ claim, it shall be so done within 72 hours of the receipt of intimation from the insured.
(2) Where the insured is unable to furnish all the particulars required by the surveyor or where the surveyor does not receive the full cooperation of the insured, the insurer or the surveyor as the case may be, shall inform in writing the insured about the delay that may result in the assessment of the claim. The surveyor shall be subjected to the code of conduct laid down by the Authority while assessing the loss, and shall communicate his findings to the insurer within 30 days of his appointment with a copy of the report being furnished to the insured, if he so desires. Where, in special circumstances of the case, either due to its special and complicated nature, the surveyor shall under intimation to the insured, seek an extension from the insurer for submission of his report. In no case shall a surveyor take more than six months from the date of his appointment to furnish his report.
(3) If an insurer, on the receipt of a survey report, finds that it is incomplete in any respect, he shall require the surveyor under intimation to the insured, to furnish an additional report on certain specific issues as may be required by the insurer. Such a request may be made by the insurer within 15 days of the receipt of the original survey report.
Provided that the facility of calling for an additional report by the insurer shall not be resorted to more than once in the case of a claim.
(4) The surveyor on receipt of this communication shall furnish an additional report within three weeks of the date of receipt of communication from the insurer.
(5) On receipt of the survey report or the additional survey report, as the case may be, an insurer shall within a period of 30 days offer a settlement of the claim to the insured. If the insurer, for any reasons to be recorded in writing and communicated to the insured, decides to reject a claim under the policy, it shall do so within a period of 30 days from the receipt of the survey report or the additional survey report, as the case may be.(6) Upon acceptance of an offer of settlement as stated in sub-regulation (5) by the insured, the payment of the amount due shall be made within 7 days from the date of acceptance of the offer by the insured. In the cases of delay in the payment, the insurer shall be liable to pay interest at a rate which is 2% above the bank rate prevalent at the beginning of the financial year in which the claim is reviewed by it.
Policyholders’ Servicing
(1) An insurer carrying on life or general business, as the case may be, shall at all times, respond within 10 days of the receipt of any communication from its policyholders in all matters, such as:(a) recording change of address;(b) noting a new nomination or change of nomination under a policy;(c) noting an assignment on the policy;(d) providing information on the current status of a policy indicating matters, such as, accrued bonus, surrender value and entitlement to a loan;(e) processing papers and disbursal of a loan on security of policy;(f) issuance of duplicate policy;(g) issuance of an endorsement under the policy; noting a change of interest or sum assured or perils insured, financial interest of a bank and other interests; and(h) guidance on the procedure for registering a claim and early settlement thereof.General
(1) The requirements of disclosure of “material information” regarding a proposal or policy apply, under these regulations, both to the insurer and the insured.
(2) The policyholder shall assist the insurer, if the latter so requires, in the prosecution of a proceeding or in the matter of recovery of claims which the insurer has against third parties.
(3) The policyholder shall furnish all information that is sought from him by the insurer and also any other information which the insurer considers as having a bearing on the risk to enable the latter to assess properly the risk sought to be covered by a policy.
(4) Any breaches of the obligations cast on an insurer or insurance agent or insurance intermediary in terms of these regulations may enable the Authority to initiate action against each or all of them, jointly or severally, under the Act and/or the Insurance Regulatory and Development Authority Act, 1999.
The IRDA has a cell that receives and looks into complaints from policyholders—Life and Non-life grievances are handled separately.
The Cell plays a facilitative role by taking up such complaints with the respective insurers.
Cases of delay/non-response:
Cases of delay/non-response in matters relating to policies and claims are taken up with the insurers for speedy disposal.
Claims/policy contracts in dispute:
Complaints relating to these are analysed and insurers are advised to examine the same. If required, their attention is called to specific issues for examination/re-examination. However, if the insurer does not change its stand even after examination/re-examination, the complainant is informed of the same. The Authority does not carry out any adjudicaton. For this, the complainant would have to approach the appropriate judicial channel.

Contact information:
Complaints against Non-life insurance companies: Y.Priya Bharath,Deputy Director/ LVS Sunitha, Junior Officer, Insurance Regulatory and Development Authority, Parisrama Bhavanam, 5-9-58/B, Basheerbagh: 500 004 Phone: 040- 55820964, 55787938: Ext: 128/119 E-mail: ypriyab@irdaonline.org, sunithalvs@irdaonline.org
Complaints against Life Insurance Companies: Sanjay Nene, Officer on Special Duty, Insurance Regulatory and Development Authroity, Parisrama Bhavanam. 5-9-58/B, Basheerbagh: 500 004 Phone: 040- 55820964, 55787938 Ext: 131 E-mail: sanjay.nene@irdaonline.org
Insurance business is “people centric” in character.one is dealing with people who are our policy holders, claimants, beneficiaries and also intermediaries.
A great deal in sensitivity is needed in dealing with our customers and consumers of insurance policy
Any service rendered to a customers needs to be assessed.this also applies to insurance business.
“Under promise and over delivery” should be the motto rather than “over promise and under-delivery”.
Insurers need to offer seamless service to their customers and not service full of seams. Like any other commercial organization, Insurers need to develop a “grievance redressal mechanism” which is both cost effective and consumer friendly.
The grievance redressal mechanism should keep a record of all complaints received and action taken till disposal. A time schedule should be laid down by the management for customer grievances and this should be strictly adhered to by all the concerned in the organization.
A record of complaints received and disposed off every month should be reported to the insurers corporate office. The grievance mechanism at the corporate office would work directly under the chief executive who in turn should periodically apprise the regulator with regard to the effectiveness of the redressal mechanism.
Apart from the customer grievance cells reporting directly to the officer incharge at all operational centers, every insurer should have an Apex grievance redressal mechanism at its corporate office. This grievance mechanism should include a retired judge of high court,the chief operating officer or executive director incharge of insurers customer service and managing director or chief executive himself.Since this is a mechanism with in the insurer’s own organization,the cost of this mechanism is to be brone by the insurer himself.
In addition, a grievance redressal authority(GRA) be setup by the IRDA comprising of one judicial member(Who should be retired chief justice or retired judge of high court) and two technical members appointed by the insurance councils well versed in insurance management and practice.the judicial officer should be the presiding officer.
This scheme can replace the existing ombudsman scheme and is to be located at all states head quarters with juridication over the state and adjoining union territory.the cost of operation of this GRA may be brone by IRDA out of its own funds or a separate fund raised by contributions from all the insurers based on their premium income.The decision of the GRA be made enforceable by any civil court.
The central Government may also constitute an insurance appellate tribunal (IAT) comprising of a retire supreme court judge and two experts in the field of insurance. All appeals against the decisions of GRA and appeal against the orders of IRDA be handled by the tribunal
The tribunal shall have the power that are vested with the state commissions under the consumer protection ACT 1986 and shall be funded by the central government.
Further appeal against the order of IAT shall lie with the supreme court of India.
Any grievance of the policy holder on any matter relating to the functioning of an insurer will have to be first submitted to the internal grievance redressal mechanism of the insurer and only if the complainant is not satisfied with the decision of the grievance redressal mechanism of the insure, It can be taken of with the GRAIt is hoped that the above redressal mechanism would go a long way in mitigating the difficulties of the holders of insurance policies and would in turn help the insurers to spread the message of insurance to all parts of the country.