A policyholder can access information on unclaimed amounts with any insurer in one place at https://bimabharosa.irdai.gov.in/Home/Unclaimed Amount
Commenting on the new regulations, Rakesh Jain, CEO, Reliance General Insurance, said, “A key feature in the circular is that grievance redressal systems will be implemented so that customers can share their experiences on how their concerns are being addressed. These grievances will be recorded on Bima Bharosa, and they can be in any form, like an email, call recording, courier, etc., as it will help the insurers buckle up and ensure their grievance officers are helping customers the right way.”
Hyderabad: Streamlining its regulations on policyholders’ right, Indian insurance regulator IRDAI has clarified that in case of group mediclaim policies, no claim can be be denied for non- availability of details of members of the group
Further, policyholder can access information on unclaimed amounts with any insurer in one place. A link is provided on Bima Bharosa at https://bimabharosa.irdai.gov.in/Home/Unclaimed Amount, said the IRDAI
According to the IRDAI, that has issued new Master Circular under part B of the IRDAI (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024 by repealing 11 circulars, insurers should promote transparency and provide a fair treatment to the policyholders.
Key aspects of the Master Circular are-
– Insurers to have a tech based robust mechanism for grievance redressal of policyholders for an efficient and speedy resolution, while also striving to move towards “zero grievances”. Insurers are required to establish regular customer interface through consumer-friendly processes, running awareness campaigns; facilitate submission of grievances online and ensure registration of all grievances; strengthen resolution processes with internal escalation matrix (if not satisfied with resolution at first level) and Internal Ombudsman Schemes,
-Advertisement Committee (approved by the Board) and/or a senior level officer of the distribution channel to examine and approve the advertisements to ensure that they are true and are not misleading,
– To make insurance accessible at remote locations of the country, Insurers are required to adopt a phygital approach (both physical and digital) to open places of business,
- Insurers to outsource permitted activities only if they are economical and efficient in providing services to the customers and/or enhance value to their business. Outsourcing activities shall be under the oversight of committee constituted by their board,
– Policyholders to get an option to avail online services or allotment of another insurance agent / sales staff for uninterrupted policy servicing even if and when an insurance intermediary is no longer associated with the insurer
Provisions to streamline group insurance business
-Insurers to issue ‘Certificate of Insurance” to all the members of a non- employer-employee group scheme,
– Consent of nominee/policyholder/beneficiary is necessary for repayment of outstanding loan amount from the proceeds of an assigned policy.
IRDAI has emphasised the importance of governance aspects for insurers. Bringing in the importance of compliance and guidance in insurance product promotions and advertisements with the committee formation will require advertising to be rigorously reminded to maintain transparency and truthfulness to benefit the policyholder’s interest.
Commenting on the new regulations, Rakesh Jain, CEO, Reliance General Insurance, said, “A key feature in the circular is that grievance redressal systems will be implemented so that customers can share their experiences on how their concerns are being addressed. These grievances will be recorded on Bima Bharosa, and they can be in any form, like an email, call recording, courier, etc., as it will help the insurers buckle up and ensure their grievance officers are helping customers the right way.”
The timelines the regulator has implemented to address these concerns are noteworthy, as they have ensured a designated officer (Ombudsman Scheme) to address these matters. Based on the activity, the addressal timeline will vary depending on the method of addressal. The circular mandates a tech-based grievance redressal system ensuring swift and efficient resolutions, aiming towards zero grievances, he said.
The goal of achieving zero grievances is ambitious yet crucial, as it reflects a dedication to resolving issues promptly and efficiently with increased standards of customer interactions and awareness, said .Shashi Kant Dahuja, executive director and chief underwriting officer, Shriram General Insurance.
By mandating that insurance services be made accessible both physically and digitally, It addresses a critical need, particularly in underserved and rural areas where access to such essential services has traditionally been limited. The digital approach, coupled with physical availability, ensures a more inclusive system where policyholders can easily obtain information, purchase policies, and manage their insurance needs without unnecessary barriers, explained Dahuja.
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I appreciate that IRDA is taking such issues which can be beneficiant to policy holders,we expect IRDA will continue to float more and more people friendly guidliness in future also.
Claim amount is not reaching the hospitals on time and the delay in settling to the hospitals make them to denying the cashless facilities to patients on a critical situation. Who needs improvement-Insurance Company or TPA or Hospital?