Resolve insurance disputes efficiently with Bima Bharosa & ombudsman

In the insurance industry, where competition is fierce, keeping customers satisfied is paramount. When customers encounter problems or feel their concerns aren't being addressed, a robust grievance resolution system becomes essential. This mechanism ensures that customer complaints are not only heard but also handled efficiently and thoroughly. The implementation of platforms like Bima Bharosa, coupled with the support provided by ombudsman offices, has created accessible channels through which insurance customers can effectively seek resolution for their issues.

 

The Bima Bharosa Portal, launched by Irdai (Insurance Regulatory and Development Authority of India) in 2022, is a key initiative designed to streamline the grievance redress process for policyholders. The portal functions as a central repository for industry-wide insurance grievance data, offering a comprehensive monitoring tool for Irdai to track market conduct issues, particularly those related to policyholder grievances.

 

Here’s how it works:

 

Grievance redressal channel: Policyholders must first approach the grievance redress channel of their respective insurance companies to resolve their complaints.

 

Escalation: If a policyholder cannot directly access the insurance company or is unable to resolve the issue, they can escalate the complaint through the Bima Bharosa Portal, which serves as a gateway to register grievances with the insurance company or Irdai.

 

Centralised access: The portal provides centralised, online access for policyholders to register complaints and for Irdai to monitor and address these issues.

 

Complaint classification and tracking: The system classifies complaints based on predefined rules, assigns unique complaint IDs, and stores them for tracking. It also sends alerts and notifications to stakeholders involved in the process.

 

Turnaround time (TAT) management: The portal defines specific target TATs for each complaint and measures the actual TAT to ensure timely resolution. Alerts are generated for pending tasks that are approaching their TATs. Rule-based workflows automatically trigger actions at appropriate stages of the grievance process.

 

If issues remain unresolved after utilising Bima Bharosa, policyholders have the option to escalate their complaints to the insurance ombudsman. This independent authority acts as a mediator between customers and insurance companies, ensuring fair treatment and accountability. The ombudsman scheme was established to facilitate cost-effective and impartial resolution of disputes without resorting to court proceedings.

 

How to ensure a smooth resolution process

 

Keep records: Document all correspondence related to the issue, including emails, letters, and call logs. This creates an organised trail of communication, helping you keep track of all interactions.

 

Maintain a timeline: Develop a clear timeline that outlines the issue's history and your desired resolution. This will help you present your case effectively and avoid confusion amidst extensive communication.

 

Follow up regularly: If the grievance system misses resolution deadlines, don't hesitate to follow up frequently. Consistent follow-ups ensure your issue remains a priority and that delays are addressed.

 

Consult experts: If the grievance is complex and persists, seek advice from financial, legal, or insurance experts. They can help you navigate the intricacies of claim delays and may offer strategies to expedite resolution.