Policyholder may contact any licensed Insurance Broker for further information Issued by IBAI in policy holder s interest

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Maurice Martin
5 years ago
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2 Dear Policyholders, Do you know your interest is protected in all Insurance policies through defined Regulations known as IRDAI (Protection of Policyholders Interest) Regulations 2017.

To ensure that insurers, distribution channels and other regulated entities fulfil their obligations

3 The objective of this regulations is to: 1. To ensure that interests of insurance policyholders are protected. 2. To ensure that insurers, distribution channels and other regulated entities fulfil their obligations towards policyholders and have in place standard procedures and best practices in sale and service of insurance policies. 3. To ensure policyholder-centric governance by insurers with emphasis on grievance redressal.

4 Is it applicable to Specific policyholders? No, IRDAI (Protection of Policyholders Interest) is applicable to all policyholders be Individual or Corporate.

Why it is after 20 years of privatization of Insurance sector? No, it is applicable since 2002 but it is revised due to change in the insurance scenario.

5 Why it is after 20 years of privatization of Insurance sector? No, it is applicable since 2002 but it is revised due to change in the insurance scenario. Earlier it was known as IRDA (Protection of Policyholder Interest) Regulations Now it is IRDAI (Protection of Policyholders Interest) Regulations 2017.

6 IRDAI (Protection of Policyholders Interest) Regulations 2017 it to Protect the interest only at the time of claim? Reg (6) No, not only at the time of claim but also It protects the Interest: At the time of sale of the insurance products At the time of issuing the policy After sale service in respect of policy document

How regulations protects the Interest before the

7 How regulations protects the Interest before the sale of the insurance products? Reg 6 (2,3,4,5) Insurers shall take steps 1. For enhancing insurance awareness so as to educate prospects 2. To prevent mis-selling 3. To make fully aware the buyer of the insurance policy about the benefits of the products

Every Insurer shall place in its website the terms and conditions of every insurance products which is

8 How to verify the features of the Product offered by the Insurers / Insurance Intermediaries /Agent? Reg (7) Under theses regulations (Protection of Policy Holders Interest) 1. Every Insurer shall place in its website the terms and conditions of every insurance products which is also available at IRDA website with unique Id number. 2. You are advised to compare the wordings displayed at website and explained to you.

9 Insurance Broker is the only channel / intermediary who represents policy holder.

10 Under a General Insurance Policy, Insurance Company shall appoint surveyor within 72 hours of the receipt of intimation from the policy holder.

11 Wherever documents are available in public domain or with a public authority, the surveyor/insurance company shall obtain them.

holder list of the essential documents and other

12 The insurance company/surveyor shall within 7 days of the claim intimation, inform the policy holder list of the essential documents and other requirements to be submitted in support of the claim.

13 The surveyor shall start the survey immediately or within 48 hours of his appointment unless there is a contingency that delays immediate survey.

14 Interim report of the physical details of the loss shall be recorded and uploaded/forwarded to the insurance company within the shortest time but not later than 15 days from the date of first visit of the surveyor.

15 A copy of the interim report of surveyor shall be furnished by the insurance company to the insured/claimant, if he so desires.

16 The surveyor shall submit his final report to the insurance company within 30 days of his appointment.

17 A copy of the surveyor s report shall be furnished by the insurer to the policy holder, if he so desires.

18 In case of Large Risks, the surveyor shall submit the final report to the insurance company within 90 days of his appointment.

19 Claims shall be settled by the insurance company within 30 days of receipt of final survey report and/or the last relevant and necessary document as the case may be.

20 It is the duty of the insurance company to furnish to the policy holder, free of charge, within 30 days of the acceptance of a proposal, a copy of the proposal submitted by the policy holder.

21 Life Insurer has to disclose the following information s to policyholders Reg 8 1. Section 45 of the Insurance Act: Policy not to be called in question on ground of mis-statement after 3 years 2. Benefits of nomination u/s 39; Do not miss to mention the name of the nominee 3. Policy should be issued within 15 days or any communication with the proposer 4. If proposal is not accepted the premium should be refunded within 15 days

the product governing the policy, its terms and conditions; name,

22 In case of a Life insurance policy, a life insurance policy shall clearly state: (i) the name and UIN allotted by the Authority for the product governing the policy, its terms and conditions; name, code number, contact details of the person involved in sales process.

days in case of electronic policies and policies obtained

23 In case of a Life Insurance Policy, policy holder has 15 days free look period from date of receipt of policy copy and 30 days in case of electronic policies and policies obtained through distance mode to review terms and cancel the same if he so desires.

24 In case of a claim under a Life Insurance Policy, any queries or requirement of additional documents, shall be raised all together and not in a piece-meal manner, within a period of 15 days of the receipt of the claim.

25 A death claim under a life insurance policy shall be paid or be rejected or repudiated giving all the relevant reasons, within 30 days.

26 If there is delay on the part of Insurance company beyond the timelines mentioned in regulations, the insurance company shall pay interest at a rate, which is 2% above bank rate from the date of receipt of last necessary document.

27 If you are unhappy with your Insurance Company - Approach the Grievance Redressal Officer of the Company Give your complaint in writing along with the necessary supporting documents Take a written acknowledgement of your complaint with the date The Insurance Company should deal with your complaint within 15 days If this does not happen or if you are unhappy with their recommended solution you can choose the other available channel to escalate the complaint to IRDAI for taking by with the company for reconsideration

28 Channels for Complaints offered by IRDAI - IGMS (Integrated Grievance Management System) registering a complaint at IGCC (IRDAI Grievance Call Centre) Calling Toll Free Number or to complaints@irda.gov.in Letter to Consumer Affairs Department, Grievance Redressal Cell, Insurance Regulatory and Development Authority of India, Sy No 115/1, Financial District, Nanakramguda, Gachibowli, Hyderabad IRDAI facilitates resolution of policyholders grievances by insurers but does not investigate into or adjudicate upon complaints

29 Options for unresolved or unsatisfactorily resolved complaints - Insurance Ombudsman Only for personal lines of Insurance Complaint in writing should be made to the concerned Ombudsman as per the jurisdiction under Redressal of Public Grievance Rules, 1998 Complaint must be grounds as per Redressal of Public Grievance Rules, 1998 Any partial or total repudiation of claims by any of claims by an insurer Any dispute about premium paid or payable in terms of the policy Any dispute on the legal construction of the policies as far as it relates to claims Delay in settlement of claims Non Issuance of any insurance document after payment of premium Please note IRDAI is not the Appellate Authority on decisions of Insurance Ombudsman.

30 This is the first of series on policy holder awareness initiated by IBAI. IBAI continuously strives to bring the best in interest of policy holder, this is an attempt in that direction.

31 Thank You

Rights and Duties of the Policyholder

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