Commercial Insurance - Claim rejected
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There can be many reasons for denial of a commercial insurance claim. The most common being- loss due to perils not covered under the policy, or a loss due to the carelessness of the policyholder.
However, the insurance company is bound to specify its reasons for such denial.
Your insurer cannot deny your claim on frivolous or technical grounds. An appeal can be made to the IRDAI against a rejected claim.
Resolver can help you connect with the right person and kickstart the process of resolution.You should know
- Contact the toll-free customer care number provided to you by the commercial insurance policy provider, you can also drop a mail on their e-mail id specified therein.
- Submit your complaint in writing, along with the necessary documents to support the complaint.
- Remember to take the written acknowledgment of your complaint duly signed with the date specified.
- You may also approach the Grievance Redressal Officer, of the commercial insurance Company.
- They usually resolve the issue within a reasonable time. However, if they don't solve within 15 days or if the result is unsatisfactory, you may approach the Grievance Redressal Cell of the Consumer Affairs Department of Insurance Regulatory and Development Authority of India (IRDAI).
- When you purchase an insurance policy/product from a Bank, it is regulated by RBI, through its appointed external Banking Ombudsman.
- Lastly, file a civil complaint with the insurer before a civil court.
How can RBI help?
The Banking Ombudsman appointed by the RBI will make a decision on your case either through conciliation or mediation between the complainant and the bank complained off. If the terms of the settlement offered by the bank are fully accepted by you, the Banking Ombudsman will pass an order as per the terms of the settlement. Further, the outcome will be binding on you and the financial organisation. Compensation offered by RBI:
- For Loss suffered: The Ombudsman has the power to direct the Bank to pay as compensation, equal to the amount of loss suffered because of the act or omission by the Bank or amount up to Rs 20 lakh, whichever is lower.
- For Mental Agony and Harassment: You will be awarded compensation not exceeding Rs.1 lakh.
If the issue is still not settled by way of an agreement within a period of one month, the Banking Ombudsman will proceed further to pass an Award. However, a reasonable opportunity is provided to both the bank and the complainant to present their case. But, this award is not binding it is upon the complainant to either accept or reject it. Upon rejecting the award, you may approach the Appellate Authority which is vested with a Deputy Governor of the RBI. It will pass the order as it may deem fit in the best of your interest.
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