Background


IRDAI is India’s insurance regulating and development body.


The Insurance Regulatory & Development Authority of India (IRDAI) was set up as a statutory body in the year 2000 based on the recommendations of the Malhotra Committee. It is headquartered at Hyderabad, Telangana State, India.


Insurance in India has a history of more than 200 years and was once a playing ground for many small and medium size insurance companies before they merged into LIC in 1956. When India opened its doors to foreign products and services, the insurance sector was not far behind. The process of re-opening of the insurance sector began in the early 1990s and the last decade has seen it open up substantially.


In 1993, the Govt. of India set up a committee under the chairmanship of Shri. R N Malhotra, former Governor of RBI, to propose recommendations for reforms in the insurance sector. The objective was to complement the reforms initiated in the financial sector.


The Malhotra Committee submitted its report in 1994 wherein, among other things, it recommended that the private sector be permitted to enter the insurance industry. They stated that foreign companies be allowed to enter by floating Indian companies, preferably a joint venture with Indian partners.


Here are some milestones relating to the setting up of the IRDAI.

  1. 1991 : Government of India begins the economic reforms programme and financial sector reforms.

  2. 1993 : Committee on Reforms in the Insurance Sector, headed by Mr. R. N. Malhotra, (Retired Governor, Reserve Bank of India) set up to recommend reforms.

  3. 1994 : The Malhotra Committee recommends certain reforms having studied the sector and hearing out the stakeholders.

  4. Some recommended reforms

    1. Private sector companies should be allowed to promote insurance companies

    2. Foreign promoters should also be allowed

    3. Government to vest its regulatory powers on an independent regulatory body answerable to Parliament


And that’s how and why the Insurance Regulatory & Development Authority (IRDAI, formerly IRDA) was set up as an autonomous body under the IRDA Act, 1999. IRDAI’s mission is to protect the interests of policyholders, to regulate, promote and ensure orderly growth of the insurance industry and for matters connected therewith or incidental thereto.


Key Activities of IRDAI

  1. Frames regulations for insurance industry in terms of Section 114A of the Insurance Act 1938.

  2. From the year 2000 has registered new insurance companies in accordance with regulations.

  3. Monitors insurance sector activities for healthy development of the industry and protection of policyholders’ interests.

The insurance sector is a colossal one and is growing at a speedy rate of 15-20%. Together with banking services, insurance services add about 7% to the country’s GDP. A well-developed and evolved insurance sector is a boon for economic development as it provides long-term funds for infrastructure development at the same time strengthens the risk-taking ability of the country.




Source : www.policyholder.gov.in, www.irda.gov.in




Objectives


IRDAI’s functions are laid down in the IRDA Act, 1999.


The key objectives of the IRDA include

  1. promotion of competition

  2. so as to enhance customer satisfaction

  3. through increased consumer choice and lower premiums,

  4. while ensuring the financial security of the insurance market.


As per the IRDA Act, following are the duties, powers and functions of IRDAI.

  1. Registering and regulating insurance companies

  2. Protecting policyholders’ interests

  3. Licensing and establishing norms for insurance intermediaries

  4. Promoting professional organisations in insurance

  5. Regulating and overseeing premium rates and terms of non-life insurance covers

  6. Specifying financial reporting norms of insurance companies

  7. Regulating investment of policyholders’ funds by insurance companies

  8. Ensuring the maintenance of solvency margin by insurance companies

  9. Ensuring insurance coverage in rural areas and of vulnerable sections of society




Source : www.policyholder.gov.in




Consumer Education


One of IRDAI’s key objectives is spreading consumer awareness on insurance.


Bima Bemisaal' is the brand name for IRDA's insurance awareness campaign. It is a consumer education initiative and has the tagline "Promoting Insurance. Protecting Insured".


Bima Bemisaal educates policyholders about their rights and obligations and informs them about the complaints resolution methods available to them. It also creates awareness about insurance among the general public. The Bima Bemisaal campaign uses various media like print, website, radio and television.


Read more about these initiatives here.


Yet another initiative is the Integrated Grievance Management System (IGMS). It helps insurance customers (policyholders) to get a dispute with the insurance company resolved through the IRDAI.


Read more about IGMS here.




Source : www.policyholder.gov.in




IGMS


IGMS has been set up by IRDAI to address insurance-related grievances.


Since MintWise is a consumer-facing website, we thought it would be educate insurance buyers about the options they have should they find any problem or have a dispute at the time of or after buying an insurance policy in India.


To enable effective monitoring of Policyholder protection Regulations and Grievance Guidelines and turnaround times thereby mandated, as well as to create a central repository of industry-wide insurance grievances’ data, IRDAI has implemented the Integrated Grievance Management System (IGMS).


IGMS provides a gateway for policyholders to register complaints with insurance companies first and if need be escalate them to the IRDAI Grievance Cells. IGMS is a comprehensive solution which not only has the ability to provide a centralized and online access to the policyholder but complete access and control to IRDAI for monitoring market conduct issues of which policyholder grievances are the main indicators. It uses a Web interface to ensure that it is accessible at all places and is real time.


It has also a mechanism to capture complaints received in physical as well as email form or voice calls received by IRDAI Grievance Call centre (IGCC).


IRDAI Grievance Call Centre can be accessed in the following ways.

  1. Call the toll free number 155255 for voice calls

  2. Send an email to complaints@irda.gov.in

The IGCC also provides details of the redressal systems of insurance companies whenever policyholders require them. Further, the IGCC also educates policyholders about the Insurance Ombudsman who provides a channel for fair disposal of complaints falling within the jurisdiction laid down.


How IGMS works

  1. The policyholder needs to login in to igms.irda.gov.in and create a profile for registering a complaint. Policy holders can register one or more complaints.

  2. Once the policy holder registers in IGMS, details of the complaint are passed on to respective insurance company. Policyholder can see the details of the branch offices of the insurance company while registering the complaint.

  3. The policyholder receives the confirmation email after registering the complaint along with IRDAI token no which will be used by IRDAI and the Insurance Company for tracking of the complaint through IGMS.

  4. A complaint registered through IGMS flows to the insurer’s computer system as well as the IRDAI repository.

  5. If the complainant (policyholder) is not satisfied with the resolution provided by insurance company, he/she can escalate the complaint for a review by IRDAI for a potential violation of Regulations.

  6. All the transactions between the Insurer, Insured and Remarks by IRDAI are visible to the complainant.


Address for communication for complaints by paper/fax

Consumer Affairs Department,

Insurance Regulatory & Development Authority of India (IRDAI),

9th Floor, United Towers,

Basheer Bagh,

Hyderabad 500 029.

Fax : +91 40 66789768




Source : www.policyholder.gov.in




Ombudsman


Get in touch with the Ombudsman if your query is not resolved by the Insurer.


The Insurance Ombudsman scheme was created by Government of India for individual policyholders to have their complaints settled out of the courts system in a cost-effective, efficient and impartial way. Any aggrieved individual who has taken an Insurance Policy on personal lines (or if deceased, the legal heir(s) under such policy) can approach the Ombudsman.


Types of Disputes/Complaints included

Complaints pertaining to repudiation of claims totally or partially, delay in settlement of claims, any dispute on the legal construction of the policies in so far as such disputes relate to claims, disputes regarding premiums paid / payable and non-issue of insurance documents.


  1. You can avail of the services of an Ombudsman only within 1 year from the date of final rejection of a case by the Insurer.

  2. No fees/charges are required to be paid.

  3. The complaint is to be made in writing and may be lodged through personal approach or through post / fax / email (followed by hard copy).

  4. Any complainant, whose complaint on the same subject matter is or was before a Court/Consumer Forum cannot approach Ombudsman.

  5. Complaints can be lodged against any Insurer both in Public Sector and Private Sector in both Life and Non-Life sectors.


You can approach the Ombudsman with complaint if...

  1. You have first approached your insurance company with the complaint and they have either (1) not resolved it, or (2) not resolved it to your satisfaction, or (3) not responded to it within 30 days.

  2. Your complaint pertains to any policy you have taken in your capacity as an individual, and

  3. The value of the claim including expenses claimed is not above Rs 20 lakhs.

Your complaint to the Ombudsman can be about...

  1. Any partial or total repudiation of claims by an insurer

  2. Any dispute about premium paid or payable in terms of the policy

  3. Any dispute on the legal construction of the policies as far as it relates to claims

  4. Delay in settlement of claims

  5. Non-issue of any insurance document to you after you pay your premium


Settling a Dispute between you and the Insurer

Giving the Recommendation and the Award

The Ombudsman will study your case and play the role of a Counsellor and Mediator. She/he will arrive at a recommendation based on the facts of the case. There are 2 possibilities/outcomes of the verdict.

  1. You can accept the recommendation as a full and final settlement. The Ombudsman will Inform the Insurer which will need to comply with the verdict in 15 days.

  2. If a settlement by recommendation does not work, the Ombudsman will pass an Award within 3 months of receiving the complaint and which will be a speaking award with the detailed reasoning binding on the insurance company but not binding on you, the policyholder. The Ombudsman may also award an ex-gratia payment. Once the Award is passed you have to accept the award in writing and the Insurer has to be informed of it within 30 days after which the Insurer needs to comply with the Award within 15 days after that.

Options you have on the Ombudsman's Verdict

You cannot appeal against a decision given by the Ombudsman as the Recommendation or Award of the Insurance Ombudsman are both subject to acceptance by the complainant in full and final settlement of the complaint. If such acceptance is not agreeable, the complainant may exercise the right to take recourse to the normal process of law against the Insurer. Further, dismissal of a complaint by the Insurance Ombudsman does not vitiate the complainants’ right to seek legal remedy against the insurers complained against, as per normal process of law.


Locate an Ombudsman near to you

There are 17 Insurance Ombudsman in different locations and you can approach the one having jurisdiction over the location of the insurance company office that you have a complaint against. Only the Ombudsman handling your jurisdiction can deal with your case. Please refer to the list of Insurance Ombudsmen in India to locate the person nearest to you.




Source : http://www.policyholder.gov.in




Contact IRDAI


IRDAI may be contacted through the following points.


Website
Head Office

Insurance Regulatory and Development Authority of India,

3rd Floor, Parisrama Bhavan,

Basheer Bagh,

Hyderabad - 500004

Ph: (040) - 2338 1100

Fax: (040) - 6682 3334

Delhi Office

Insurance Regulatory and Development Authority of India,

Gate No. 3, First Floor, Jeevan Tara Building,

Sansad Marg,

New Delhi - 110001

Ph: (011) - 2344 4400

Fax: (011) - 2374 7650

Mumbai Office

Insurance Regulatory and Development Authority of India,

Ground Floor, Royal Insurance Building,

12, J. Tata Road,

Mumbai - 400 020

Ph: (022) - 2289 8600

I am looking for

Mon - Sat: 10 AM TO 7 PM

Email Us

Mon - Sat: 10 AM TO 7 PM

WhatsApp 24 x 7