Insurance Ombudsmen have sought more powers to settle higher claim cases as the number of complaints continue to increase.
“Ombudsmen should be conferred with more powers and the Government was yet to consider this aspect. Even the GBIC (governing body of the insurance council) as well as IRDA had recommended to the Government of India (Department of Financial Services) and “nothing has happened till date,” Virander Kumar, Insurance Ombudsman, said while speaking at the insurers meet conducted by the Office of Insurance Ombudsman here on Wednesday.
At present, Ombudsman offices are dealing with claims up to Rs.20 lakh. This limit was set in 1998 and no amendments were made since then, he said. The plea was to increase the limit to Rs.50 lakh due to a rise in high value policies. Secondly, action has to be initiated against those agents mis-selling insurance products, he said adding, “the protection of policy holders interest (PPI) regulations are very old and these should be amended.”
Also, the grievance redressal procedures, were not followed. If these were adhered to, number of grievances would come down, he said. Insurance companies deploy the same person looking after the claims to look after grievance redressal which is a violation of the rules, he said.
During 2014-15, Ombudsman offices received 31,101 complaints at all-India level and had disposed 24,319. One-fourth of the complaints were agents-related.
Mr. Virander said the aim of the insurers meet was to highlight the role and functions of Insurance Ombudsmen in redressing the complaints or grievances of policy holders and discuss various issues relating to business of insurance, which would result in bringing improvements in customer service.
Ninety nine per cent of the Ombudsmen awards were honoured while only some of them were challenged in consumer courts. 61 per cent of the rulings were in favour of the policy holders and 39 per cent in favour companies, he said.
Regarding portability of insurance schemes, insurance agents should clearly explain to the policy holders about the procedures involved on the transfer of pre-existing disease benefits to the new company.