Insurance Broker Miscommunication: Need Help with Denied Treatment Coverage
8 months ago
An insurance broker confirmed to me via email that a treatment was covered, but after availing the treatment, the insurance company denied payment. Now the broker is not taking responsibility for their communication. What should I do in this case? I proceeded with the treatment solely based on the broker's communication.
A.Dear Client,
Misleading information by an Insurance agent or broker is termed as professional misconduct under Regulation 21, Schedule - III of IRDA (Insurance Brokers) Regulations, 2002. So on repudiation of a claim by the Insurance Company, you may file a complaint against the Insurance Broker for professional misconduct to the concerned Insurance Company and IRDA for redressal of your grievance.
Misleading information by an Insurance agent or broker is termed as professional misconduct under Regulation 21, Schedule - III of IRDA (Insurance Brokers) Regulations, 2002. So on repudiation of a claim by the Insurance Company, you may file a complaint against the Insurance Broker for professional misconduct to the concerned Insurance Company and IRDA for redressal of your grievance.
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A.Dear client,
You may approach the insurance ombudsman.
Under Rule 12 of Redress of Public Grievances 1998 Insurance Ombudsman has power under Section 12(1)(b) in the Redressal of Public Grievances Rules, 1998to act as a counsellor or mediator which are related to any partial or total repudiation of claims by an insurer.
b.The person in authority shall give in writing about the settlement done between in the policyholder and the insurer.
c.The decision made by the Insurance shall be binding and final on both the parties.
d.If policyholder wants to approach Insurance Ombudsman, he can approach without a lawyer too.
You can also approach the IRDA.
Grievance Redressal Cell in the Consumer Affairs Department of the IRDA looks into complaints/grievances from policyholders. Before approaching the IRDA Cell, the complaints against insurers are required to be first registered with the Complaints/Grievance Redressal Cell of the concerned insurer.
You may approach the insurance ombudsman.
Under Rule 12 of Redress of Public Grievances 1998 Insurance Ombudsman has power under Section 12(1)(b) in the Redressal of Public Grievances Rules, 1998to act as a counsellor or mediator which are related to any partial or total repudiation of claims by an insurer.
b.The person in authority shall give in writing about the settlement done between in the policyholder and the insurer.
c.The decision made by the Insurance shall be binding and final on both the parties.
d.If policyholder wants to approach Insurance Ombudsman, he can approach without a lawyer too.
You can also approach the IRDA.
Grievance Redressal Cell in the Consumer Affairs Department of the IRDA looks into complaints/grievances from policyholders. Before approaching the IRDA Cell, the complaints against insurers are required to be first registered with the Complaints/Grievance Redressal Cell of the concerned insurer.
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