Insurance Issues

Insurance Issues—Resolving Claim Disputes, Misselling & Delays

Insurance is a crucial financial safeguard, offering protection during unexpected medical emergencies, life events, or asset-related losses. However, many policyholders face frustration when their claims are unfairly rejected, settlements are delayed, or they realize they’ve been mis-sold insurance products without full disclosure. These challenges are not only financially distressing but also emotionally exhausting, especially during already stressful times.

Bank Samadhan, in association with SettleMyClaim.in, provides a comprehensive insurance grievance redressal platform. This service is designed to address unfair insurance practices, delayed settlements, forced or bundled policies, and all forms of misrepresentation. The objective is to ensure that policyholders are not left vulnerable due to insurer negligence or miscommunication.

Types of Insurance Issues Commonly Faced

• Claim Rejection Without Justification: Claims turned down without valid reasoning or against policy norms.

• Unreasonable Settlement Delays: Weeks or months of waiting even after submission of all documents.

• Mis-sold Policies: Policies sold by misrepresenting facts—e.g., ULIPs sold as fixed deposits.

• Forced Insurance Sales: Insurance policies forcibly included during home loan or vehicle loan processing.

• Incomplete or Hidden Clauses: Exclusions or conditions not explained at the time of purchase.

• Policy Record Errors: Incorrect beneficiary details, premium errors, or missing documentation.

• Disputed Surrender/Claim Amounts: Final claim amounts not matching promised or expected payouts.

• Poor Customer Service: Insurer failing to respond to queries or complaints within regulatory timelines.

How the Dispute Resolution Process Works

• Document Review & Policy Audit
  The policy document, claim forms, and all related correspondence are thoroughly examined to understand the issue.

• Issue Diagnosis
  The nature of the dispute is identified—whether it’s a delay, denial, or sale malpractice—and cross-checked against regulatory guidelines.

• Drafting and Filing of Grievance
  A detailed complaint is prepared and formally submitted to the insurance company’s internal grievance cell.

• Escalation to IRDAI or Ombudsman (if needed)
  If resolution is not provided within prescribed timelines, the matter is escalated to external regulatory bodies like IRDAI or the Insurance Ombudsman.

• Regular Follow-Up
  Status is tracked, and the customer is updated throughout the process until a decision is reached.

• Advisory Support
  In some cases, alternative options such as revised claims, corrections, or settlement re-evaluation are explored.

Key Benefits of Resolving Insurance Issues Promptly

• Prevents unnecessary financial strain

• Secures rightful policy benefits

• Upholds fair market practices and regulatory rights

• Safeguards consumer interest under IRDAI guidelines

• Ensures transparency and accountability from insurers

• Improves awareness and understanding of policy terms

Important Guidelines for Policyholders

• Always read and retain your policy documents and proposal forms.

• Use the 15-day free-look period to cancel a policy without penalties.

• Never sign blank forms or accept verbal promises from agents.

• Track every premium payment and ensure your nominee details are correct.

• Ask for written clarification on exclusions or complex terms.