grievance redressal mechanism
Grievance Redressal Mechanism
We have established a Grievance Redressal Mechanism to assist in the resolution of any complaint, grievance or dispute in respect of the Policy. You are requested to submit your written complaint at any of the below mentioned touch points:
• Toll free customer care number: 1-800-2121-212 (9:00 am to 9:00 pm, 7 days a week).
• Email us at: firstname.lastname@example.org / email@example.com
• Write to us at: Customer Care, Edelweiss Tokio Life Insurance Company Ltd, 6th Floor, Tower 3, Wing ‘B’, Kohinoor City, Kirol Road, Kurla (W), Mumbai 400070.
• You can lodge your grievance/complaint at any of our branches/offices
If you do not receive any resolution to your complaint within a period of 2 weeks or if the response is not as per your expectations, please feel free to contact our Grievance Redressal Officer, at any of the below touch points:
• +91-22-71013322 (Between 10 am to 7 pm on Monday to Friday, except public holidays).
• Write to us at: Customer Care, Edelweiss Tokio Life Insurance Company Limited, 6th Floor, Tower 3, Wing ‘B’, Kohinoor City, Kirol Road, Kurla (W), Mumbai 400070.
If you are not satisfied with the response of the GRO or do not receive a response from us within 14 days, you may approach the Grievance Cell of Insurance Regulatory and Development Authority of India (IRDAI’’) on the following contact details:
• IRDAI Grievance Call Centre (IGCC) - Toll free No: 155255
• Email ID: firstname.lastname@example.org
• Register online at: http://www.igms.irda.gov.in/
Address for communication for complaints by fax/paper:
Consumer Affairs Department
Insurance Regulatory and Development Authority of India
Sy. No. 115/1
Hyderabad – 500 032, Telangana
Fax No: 91- 40 – 20204000
If the complaint/grievance has still not been resolved you may at any time approach the Office of the Insurance Ombudsman established by the Central Government of India as per Rule 13 and 14 of the Insurance Ombudsman Rules, 2017 (‘Insurance Ombudsman Rules’).
Powers of Insurance Ombudsman under Rule 13 of the Insurance Ombudsman Rules:
The Ombudsman shall receive and consider the following complaints or disputes relating to:
a. delay in settlement of claims, beyond the time specified in the regulations, framed under Insurance Regulatory and Development Authority of India Act, 1999;
b. any partial or total repudiation of claims by the Company;
c. disputes over premium paid or payable in terms of insurance policy;
d. misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
e. legal construction of insurance policies in so far as the dispute relates to claim;
f. policy servicing related grievances against the Company and their agents and intermediaries;
g. issuance of life insurance policy including health insurance policy which is not in conformity with the proposal form submitted by the proposer;
h. non-issuance of insurance policy after receipt of premium in life insurance including health insurance; and
i. any other matter resulting from the violation of provisions of the Insurance Act, 1938 or the regulations, circulars, guidelines or instructions issued by the IRDAI from time to time or the terms and conditions of the policy contract, in so far as they relate to issues mentioned at clauses (a) to (f) as mentioned above.
Manner in which complaint is to be made in accordance with Rule 14 of the Insurance Ombudsman Rules:
1. Any person who has a grievance against the Insurer/Company/Us, may himself or through his legal heirs make a complaint in writing to the Ombudsman within whose territorial jurisdiction the branch or office of the Company, complaint against or the residential address or place of residence of the complainant is located.
2. The complaint shall be in writing duly signed by the complainant or through his legal heirs, nominee or assignee and shall state clearly the name and address of the complainant, the name of the branch or office of the insurer against which the complaint is made, the fact giving rise to complaint, supported by documents, the nature and extent of the loss caused to the complainant and the relief sought from the Ombudsman.
3. No complaint to the Insurance Ombudsman shall lie unless:
(a) the complainant makes a written representation to the Company named in the complaint and—
i. either the Company had rejected the complaint; or
ii. the complainant had not received any reply within a period of one month after the Company received the complainant’s representation; or
iii. the complainant is not satisfied with the reply given to him by the Company;
(b) The complaint is made within one year—
i. after the order of the Company rejecting the representation is received; or
ii. after receipt of decision of the Company which is not to the satisfaction of the complainant;
iii. after expiry of a period of one month from the date of sending the written representation to the Company if the Company named in the complaint fails to furnish reply to the complainant.
4. The Insurance Ombudsman shall be empowered to condone the delay in filing a complaint as mentioned above under (3) (b), as he may consider necessary, after calling for objections of the Company against the proposed condonation and after recording reasons for condoning the delay and in case the delay is condoned, the date of condonation of delay shall be deemed to be the date of filing of the complaint, for further proceedings under the Insurance Ombudsman Rules.
5. No complaint before the Insurance Ombudsman shall be maintainable on the same subject matter on which proceedings are pending before or disposed of by any court or consumer forum or arbitrator.
You may refer to the list of Ombudsman with their addresses on http://ecoi.co.in/ombudsman.html