Submitted by: Bima Deals

The IRDA has recently established the Consumer Affairs Department to give a special focus to and oversee the compliance by insurers of the IRDA Regulations for Protection of Policyholders Interests and also to empower consumers by educating them regarding details of the procedures and mechanisms that are available for grievance redressal. Policyholders must be provided with inexpensive and speedy mechanisms for complaints disposal and the IRDA (Protection of Policyholders Interests).

In 2002 IRDA made regulations that made it necessary for insurers to have efficient and speedy grievance redress mechanisms. The regulator issued Guidelines for Grievance Redressal, which laid down specific timeframes and turnaround times (TATs) for response, resolution, etc., which would further strengthen the redressal systems insurers already have in place.

IRDA monitors the effectiveness of the mechanism by creating a central repository of industry-wide insurance grievance data; IRDA is on path to implement the Integrated Grievance Management System (IGMS). IGMS will create a gateway for policyholders to register complaints with insurance companies first and if need be to escalate them to the IRDA Grievance Cell. 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 IRDA for monitoring market conduct issues of which policyholder grievances are the main indicators. IGMS will have the ability to classify different complaint types based on pre-defined rules. The system will be able to assign, store and track unique complaint IDs and also enable intimation to various stakeholders as required, within the workflow. The system will enable defining of Target Turnaround Times (TATs) and measure the actual TATs on all complaints. The system will set up alerts for pending tasks nearing the laid down Turnaround Time. Thus, the system will automatically trigger activities at the appropriate time through rule based workflows.

A complaint registered through IGMS will flow simultaneously to the insurer s system as well as the IRDA repository. Updation of status by the insurers would automatically be mirrored in the IRDA system. IGMS will be able to generate reports on all criteria like ageing, status, nature of complaint and any other parameter that is defined. Thus, the IGMS will provide a standard platform to all insurers to resolve policyholder grievances and to provide IRDA with a tool to monitor the effectiveness of the grievance redressal system of insurers.

IRDA has recently introduced the IRDA Grievance Call Centre (IGCC) that provides for a toll free number 155255. IGCC provides an additional channel for policyholders to lodge their grievances and also seek their status over phone/e-mail. The Call Centre environment will interface with IGMS, once the IGMS is implemented. The IGCC has enabled policyholders easy access to the grievance redressal cell of IRDA both through telephone and e-mail, apart from providing details of the redressal systems of insurance companies whenever policyholders require them. The Call Centre carries out filling of grievance registration forms on the basis of the call. The IGCC also provides a channel for tracking of grievances. Further, the IGCC also educates policyholders about the Insurance Ombudsman who provides a channel for fair disposal of complaints falling within the laid down jurisdiction.

With a view to going beyond facilitation of complaints resolution, IRDA has begun to drill down into details of complaints to identify instances of violation/non-compliance of various provisions of the applicable Regulations through enquiries and inspections. If needed, regulatory action is taken.

Insurance Ombudsman is reviewed for possible changes and expansion of jurisdiction, to ensure that grievances that are not resolved by insurers and get escalated to the Regulator and/or Ombudsman are decided conclusively, except where they would fall necessarily within the ambit of the courts.

Source: IRDA Annual Report 2009-10.

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