The Insurance Regulatory and Development Authority of India (IRDAI) has developed a structured grievance redressal mechanism to ensure policyholders receive timely and fair resolutions to their complaints. This multi-tiered approach provides various levels of recourse, starting with the insurer and escalating to higher authorities if necessary. By empowering policyholders with clear guidelines, IRDAI ensures transparency and accountability in handling grievances related to insurance policies. Below is a detailed guide to navigating the grievance redressal process effectively.

1. Approach the Insurer First
   1. Contact the Customer Care:
      • Call the insurer’s toll-free number or send an email to the customer care team. Many insurers also provide online portals or mobile apps to lodge complaints.
   2. Submit the Grievance in Writing:
      • o Draft a written complaint outlining the issue with supporting documents (e.g., policy copy, claim rejection letter, or communication history).
   3. Grievance Redressal Officer (GRO):
      • All insurers are required to appoint a Grievance Redressal Officer (GRO). Policyholders can directly escalate their grievances to the GRO for resolution.
   4. Response Time:
      • Insurers must acknowledge the complaint within 3 days and resolve it within 15 days as per IRDAI rules.
2. Escalate to IRDAI’s Integrated Grievance Management System (IGMS)
   • If the insurer does not resolve the grievance within the stipulated time or the resolution is unsatisfactory, the policyholder can escalate the issue to IRDAI.
   • How to Use IGMS:
     • Visit the IRDAI portal: IRDAI Integrated Grievance Management System (IGMS)
     • Register and submit your complaint along with supporting documents.
   • Tracking Status:
     • The IGMS platform allows policyholders to track their complaint status and responses.
3. File a Complaint with the Insurance Ombudsman
   1. If the grievance remains unresolved or the policyholder is not satisfied with the response, they can approach the Insurance Ombudsman.
   2. Eligibility
      • The complaint must be filed within 1 year from:
        1. The date of rejection or unsatisfactory resolution by the insurer.
        2. The date of the insurer's failure to respond within 15 days.
   3. Complaints Handled:
      • Claim rejections or delays.
      • Disputes regarding premiums or policy terms.
      • Refund issues.
      • Mis-selling of insurance products.
   4. How To File:
      • Submit a written complaint to the Ombudsman office serving the policyholder’s region.
      • Include all supporting documents (e.g., policy copy, insurer response, and grievance details).
   5. Process:
      • The Ombudsman conducts a hearing and may pass an order binding on the insurer.
   6. Resolution Timeline:
      • Cases are typically resolved within 3 months of filing the complaint.
4. Approach Consumer Forums or Courts (if needed)
   1. If the Ombudsman’s decision is unsatisfactory or the matter involves larger issues, policyholders can approach:
      1. Consumer Disputes Redressal Commission (District, State, or National level).
      2. Civil Courts for legal resolution.
   2. Time Limit: File a complaint within 2 years of the grievance.
5. Key Tips for Filing Grievances
   1. Maintain Records: Keep copies of all correspondence, emails, and documents related to the grievance.
   2. Be Specific: Clearly explain the issue, referencing policy numbers, claim numbers, and dates.
   3. Know Your Rights: Familiarize yourself with IRDAI regulations, especially regarding claims, refunds, and policy cancellation.
6. IRDAI Contact Information
   1. Toll-Free Number: 155255 or 1800-425-4732.
   2. Email: complaints@irdai.gov.in.
   3. Postal Address:
      1. IRDAI Grievance Cell, Sy No. 115/1, Financial District, Nanakramguda, Gachibowli, Hyderabad - 500032.