When businessman Mukesh Garg's two claims were rejected, he represented himself before the insurance ombudsman, a statutory body for out-of-court settlements, but sought third-party help with the paperwork—a decision he later regretted.
"Two of my claims got rejected in a year. The ombudsman issued an award in my favour in the first one, but when he found out that a company helped me out, he did not hear my case and passed an award against me in the second one."
Garg's situation highlights a significant challenge in the system. While the policyholder and insurance company get a chance to present their cases, neither can engage a lawyer or third party.
For most policyholders, navigating this process can be daunting. After an insurer rejects a claim, a policyholder's first step is approaching the insurer's grievance handling department. If the issue is not resolved, they can reach out to the ombudsman. The hearing date is fixed and both sides present their arguments either online or physically.
No level-playing field
One does not have to pay any fee to lodge a complaint with the ombudsman. It is a cost-effective system where claims up to ₹50 lakh can be resolved. However, people unaware of its existence or those who do not understand the process may reach out to third parties seeking support. Ombudsman officers can't learn about it, but if they do, they may view it in a negative light.
A couple of complainants told Mint they were asked to write a letter stating they would not pay money to any third party. Mint has seen one such copy.
"I was told my case is genuine but I still would not get my claim because I sought an agency's help in filing my case with the ombudsman. I am in a full-time job. My husband has health issues. I don't understand insurance. If I sought somebody's help in doing the paperwork to ease my burden, why is it wrong?" said a person seeking anonymity as her case is sub-judice.
هذه القصة مأخوذة من طبعة December 20, 2024 من Mint Ahmedabad.
ابدأ النسخة التجريبية المجانية من Magzter GOLD لمدة 7 أيام للوصول إلى آلاف القصص المتميزة المنسقة وأكثر من 9,000 مجلة وصحيفة.
بالفعل مشترك ? تسجيل الدخول
هذه القصة مأخوذة من طبعة December 20, 2024 من Mint Ahmedabad.
ابدأ النسخة التجريبية المجانية من Magzter GOLD لمدة 7 أيام للوصول إلى آلاف القصص المتميزة المنسقة وأكثر من 9,000 مجلة وصحيفة.
بالفعل مشترك? تسجيل الدخول
Target Global Chip Shifts, Not Self-Sufficiency: Chris Miller
The Chip War author batted for strategic focus on diversification of global tech innovation
Avendus launches third pvt credit fund
The asset management arm of Avendus Group, Avendus PE Investment Advisors, on Wednesday launched its third private credit investment vehicle targeting to raise more than double the capital secured for the last vehicle, with the first close expected next month, VCCircle has gathered.
India to simplify tax filing rules in budget
The government plans to simplify income tax filing rules to make it less tedious for taxpayers to comply with the law and help cut down on disputes that have ballooned to more than $120 billion over the past decade.
India Eyes Intra-State Linking of Rivers to Combat Drought and Floods
India's water crisis is a tale of extremes—while some regions battle floods, others face parching droughts.
PMO working on blueprint to industrialize North India
The govt is focusing on bridging the North-South divide by pushing investment in the North
Govt Revises Gold Import Data, Nov Trade Deficit to Shrink
The government has revised gold import data, bringing down numbers for November by $5 billion (₹42,950 crore) to $9.84 billion, possibly to rectify double accounting of inbound shipments.
Why farm growth held up as other key sectors slowed down
India's farm economy, which employs nearly half the population, is forecast to outperform other key sectors during 2024-25, but the expansion is partly due to a so-called base effect, analysts said on Wednesday, a day after the release of full-year official estimates of gross domestic product (GDP) growth.
CES 2025: What Lies Ahead in Tech This Year
With more powerful computing chips, the idea of PCs compact enough to be carried around in one hand is becoming real
Kick off the new year with fresh games
Despite a typical slow pace, Jan 2025 features several new game releases
A flagship to challenge most top smartphones in 2025
The vivo X200 Pro may emerge as the camera phone to beat in 2025. What else does the flagship have going for it?
