Insurance Sector

History of Insurance in India- In India, insurance has a deep-rooted history. It finds mention in the writings of Manu ( Manusmrithi ), Yagnavalkya ( Dharmasastra ) and Kautilya ( Arthasastra ). In the British period history can be traced backed from 1818 when life insurance business in India with the establishment of the Oriental Life Insurance Company in Calcutta. Today insurance sector is the fastest growing sector in India. 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 strengthening the risk taking ability of the country. For further detail visit to www.irda.gov.in .

Some Important Insurance laws-

Acts-

1- The Insurance Act, 1938

2- The IRDA Act, 1999

Regulations-

1- IRDA (Protection of policy holders interests ) regulation 2002

Ombudsman Scheme- The institution of Insurance Ombudsman was created by the Government of India vide its notification dated 11th November, 1998 to handle complaints of aggrieved insured persons. Claimants who could not get their complaints redressed by insurers may get in touch with the Ombudsman relevant to their states. This institution is of great importance and relevance for the protection of interests of policy holders and also in building their confidence in the system. The institution has helped to generate and sustain the faith and confidence amongst the consumers and insurers. Details of Ombudsmen can be obtained from IRDA’s website www.irdaindia.org or from any insurer’s office.

Appointment of Insurance Ombudsman-

The governing body of insurance council issues orders of appointment of the insurance Ombudsman on the recommendations of the committee comprising of Chairman, IRDA, Chairman, LIC, Chairman, GIC and a representative of the Central Government. Insurance council comprises of members of the Life Insurance council and general insurance council formed under Section 40 C of the Insurance Act, 1938. The governing body of insurance council consists of representatives of insurance companies.

Eligibility

Ombudsman are drawn from Insurance Industry, Civil Services and Judicial Services.

Terms of office

An insurance Ombudsman is appointed for a term of three years or till the incumbent attains the age of sixty five years, whichever is earlier. Re-appointment is not permitted..

Territorial jurisdiction of Ombudsman

he governing body has appointed twelve Ombudsman across the country allotting them different geographical areas as their areas of jurisdiction. The Ombudsman may hold sitting at various places within their area of jurisdiction in order to expedite disposal of complaints. The offices of the twelve insurance Ombudsmans are located at (1) Bhopal, (2) Bhubaneswar, (3) Cochin, (4) Guwahati, (5) Chandigarh, (6) New Delhi, (7) Chennai, (8) Kolkata, (9) Ahmedabad, (10) Lucknow, (11) Mumbai, (12) Hyderabad. The areas of jurisdiction of each Ombudsman has been mentioned in the list of Ombudsman.

Office Management

The Ombudsman has a secretarial staff provided to him by the insurance council to assist him in discharging his duties. The total expenses on Ombudsman and his staff are incurred by the insurance companies who are members of the insurance council in such proportion as may be decided by the governing body.

Removal from office

An Ombudsman may be removed from service for gross misconduct committed by him during his term of office. The governing body may appoint such person as it thinks fit to conduct enquiry in relation to misconduct of the Ombudsman. All enquiries on misconduct will be sent to Insurance Regulatory and Development Authority which may take a decision as to the proposed action to be taken against the Ombudsman. On recommendations of the IRDA, the Governing Body may terminate his services, in case he is found guilty.

Power of Ombudsman

Insurance Ombudsman has two types of functions to perform (1) conciliation, (2) Award making. The insurance Ombudsman is empowered to receive and consider complaints in respect of personal lines of insurance from any person who has any grievance against an insurer. The complaint may relate to any grievance against the insurer i.e. (a) any partial or total repudiation of claims by the insurance companies, (b) dispute with regard to premium paid or payable in terms of the policy, (c) dispute on the legal construction of the policy wordings in case such dispute relates to claims; (d) delay in settlement of claims and (e) non-issuance of any insurance document to customers after receipt of premium.

Ombudsman’s powers are restricted to insurance contracts of value not exceeding Rs. 20 lakhs. The insurance companies are required to honour the awards passed by an Insurance Ombudsman within three months.

Manner of lodging complaint

The complaint by an aggrieved person has to be in writing, and addressed to the insurance Ombudsman of the jurisdiction under which the office of the insurer falls. The complaint can also be lodged through the legal heirs of the insured. Before lodging a complaint:

i) the complainant should have made a representation to the insurer named in the complaint and the insurer either should have rejected the complaint or the complainant have not received any reply within a period of one month after the concerned insurer has received his complaint or he is not satisfied with the reply of the insurer.
ii) The complaint is not made later than one year after the insurer had replied.
iii) The same complaint on the subject should not be pending with before any court, consumer forum or arbitrator.

Recommendations of the Ombudsman

When a complaint is settled through the mediation of the Ombudsman, he shall make the recommendations which he thinks fair in the circumstances of the case. Such a recommendation shall be made not later than one month and copies of the same sent to complainant and the insurance company concerned. If the complainant accepts recommendations, he will send a communication in writing within 15 days of the date of receipt accepting the settlement.

Award

The ombudsman shall pass an award within a period of three months from the receipt of the complaint. The awards are binding upon the insurance companies.

If the policy holder is not satisfied with the award of the Ombudsman he can approach other venues like Consumer Forums and Courts of law for redressal of his grievances.

As per the policy-holder’s protection regulations, every insurer shall inform the policy holder along with the policy document in respect of the insurance Ombudsman in whose jurisdiction his office falls for the purpose of grievances redressal arising if any subsequently.

Steady increase in number of complaints received by various Ombudsman shows that the policy-holders are reposing their confidence in the institution of Insurance Ombudsman.

Complainant Form-

Complaint Form – Life Insurance
Complaint form – Non-life Health

What is New-

IGMS- Now a policy holder can register complainant online also by using the Integrated Grievance Management System (IGMS) system. For further detail please visit to the www.igms.irda.gov.in/

Portability of Health Insurance Policies- Persons shifting from one region to other regions are many times put to disadvantage due to lack of insurers’ office providing necessary policy servicing at the new location. Further, employees shifting from one organization to another organization many times lose health insurance cover due to lack of portability of the health insurance policies. It is essential to protect the policyholders against discontinuity and consequential loss of Pre Existing Diseases (PED) cover by making the health insurance plans portable across the insurance companies. The portability will also ensure that the policyholder is not tied to one single insurer throughout his life for fear of losing the cover of PED.

The main features of portability are :

1. The credit from the period elapsed excluding PED shall be carried forward to the new insurer.

2. The accepting insurer shall provide cover, atleast upto the sum assured in the previous insurance policy.

3. The request for porting the policy shall be completed as per the timelines prescribed in the IRDA (Protection of Policyholders’ Interests) Regulations and guidelines.

This portability plan shall come into force from the 1st July 2011.