Insurance
Insurance problems: How to get justice from Ombudsman in a cost-effective way
If you have a dispute with your insurer, you can approach the Insurance Ombudsman without any help from a lawyer. Speaking at a Moneylife Foundation interactive seminar, AK Dasgupta, Insurance Ombudsman from Mumbai said, policyholder can get justice if she can follow due procedure and prove her case without hassle
 
Insurance grievances are on a rise. Both life and non-life have almost equal share of  complaints. The main difference is that life insurance complaints has mis-selling by intermediary, while non-life insurance has grievances against third party administrator (TPA) or surveyor. Wrongful denial or partial settlement of claims is a major grouse of policyholders. The other reasons for complaint are: Any dispute in regard to premium paid or payable in terms of the policy, Any dispute on the legal construction of the policies in so far as such disputes relate to claims, Delay in settlement of claims and Non-issue of any insurance document to customers after receipt of premium.
 
Speaking at an interactive seminar organised by Moneylife Foundation at Mumbai, AK Dasgupta, Insurance Ombudsman for the region, said, “Almost 90%-95% of grievances we receive are related to claim settlements. Insurer's policy document is in such small letters that even the company representative could not read this. There is a lot of scope for improvement in handling grievances and we want customers to give us suggestions.”
 
Mr Dasgupta took charge of the Mumbai Ombudsman office in mid-May 2013. Over the period of last one year, Mumbai Ombudsman has solved more than 1,400 complaints, which is three to four times of the average complaints handled in an ombudsman office. Mumbai Ombudsman invited life and non-life insurance companies to take up non-complex cases for reconsideration. More than half of the cases were solved without any need of policyholder hearing. The decision was given in the favour of the customer. Thus, all the old cases (few of 2009-10) were closed and the ombudsman office started dealing with 2012-13 cases. The ombudsman office has started giving priority to senior citizen cases and those with critical illness. There was a need felt to help these consumer groups faster, so that any unfair claims rejection or partial settlement is given justice.
 
More and more people are now using Ombudsman route to resolve their insurance related issues. “I, till date, have not come across any case where the policyholder was not willing to accept the decision given by the Ombudsman,” Mr Dasgupta said adding, “the order for award has a timeline for insurer to pay. If the insurer has not paid award within stipulated time given in Ombudsman’s order, then interest is levied.”
 
He said while approaching Ombudsman for insurance grievances, policyholder needs to submit reasonable proof of claim submission. Even acknowledgment from courier can be considered as proof of submission for claim. But you need to first approach the insurer and if there is no response or the insurer has not responded in reasonable time, then you can reach Ombudsman’s officer, Mr Dasgupta said.
 
Regulations require the complaint to be resolved within 90 days of receipt, but it is unlikely any ombudsman office is able to adhere to the time line. The delay is due to overload of pending cases when the ombudsman takes charge of office. There are delays in appointment of ombudsman, which means there are several months, wherein there is no ombudsman, and hence, cases can pile on. Complaints  can be settled, through mediation or agreement. When the complaint is not settled by mutual agreement the Ombudsman shall pass an award. The award to cover the losses suffered by the complainant shall not exceed  Rs20 lakh. The awards are binding upon insurance companies. If the policyholder is not satisfied with the ombudsman’s award he can approach other forums such as consumer forums and courts for redressal. 
 
Insurance ombudsman can only address grievance on policies on personal lines (both life and general insurance) or if deceased, the Nominee/legal their(s) of the deceased can make a complaint to the Insurance Ombudsman. It means businesses cannot approach ombudsman for grievance handling. Complaints are not entertained if : Complaint made one year after the insurer has rejected the claim, Complaint is on the same subject for which proceedings were made or pending before any court/consumer forum/arbitrator. Claim amount / Compensation more than Rs20 lakh.
 
If you have already made written representation to the Grievance Redressal Cell of the insurer and have no response or unsatisfactory response, you can approach Insurance Ombudsman under whose territorial jurisdiction the complainant resides. There are 16 Ombudsman offices: Ahmedabad, Bhopal, Chandigarh, Delhi, Hyderabad, Kochi, Lucknow, Noida, Pune, Bengaluru, Bhubaneshwar, Chennai, Guwahati, Jaipur, Kolkata, Mumbai and Patna. Metros like Mumbai and Delhi get high volume of complaints. There is no need for legal representation to fight your case as ombudsman services are meant to be low cost option to get justice. 

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COMMENTS

vikas Raghunath Patil

2 years ago

सावधान, आर्थिक धोका व शास्त्रोक्त फसवणूक

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सर्व सामान्य नोकरदार मंडळी ज्यांचे बँक खाते cosmos बॅंक मध्ये असेल त्यांनी जर चुकून बजाज अलींझा ची ५ वर्षाची policy काढली असेल तर आपल्या हाती भोपळा व मनस्ताप नक्की आहे म्हणून आपण अश्या अमिशाना बळी पडू नका .
माझ्या सोबत BAJAJ ALLIANZA आणि COSMOS BANK चिंचवड ने धोका केला आहे .
सविस्तर :
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मी भरले २५०००. ०० त्यातून मला मिळाले २३४२३. ०० म्हणजे मला पाच वर्षाने माझे मुद्धल तर नाहीच व्याज पण नाही उलट १५७७. ०० / Rs. मला घाटा आला आहे (एक हजार सत्त्यातर रुपये घाटा ) फायदा तर (भोपळा) ००० नाहीच .
COSMOS BANK मध्ये जर आपण कोणी अश्या प्रकारची स्कीम घेतली असेल तर त्वरित ती बंद करावी कारण हि स्कीम फसवी आहे
COSMOS BANK सारख्या नामांकित बँकेने असली स्कीम आपल्या ग्राहकांच्या माथी मारली हि अतिशय लाजिरवाणी व धोका देणारी मानसिकता आहे या बाबत COSMOS BANK पदाधिकार्यांनी जाहीर माफी मागावि.
BAJAJ ALLIANZA या कंपनीवर आर्थिक फसवणूक केल्या बाबत पोलिस केस करणे गरजेचे आहे. COSMOS BANK ने २२०० ग्राहकांना ह्या संकटात टाकून जनतेची फसवणूक केली आहे
ह्या बाबत सर्व कागद पत्र सोबत जोडली आहेत

BAJAJ ALLIANZA policy NO : 0121779517
member id : CB 5F500203
नागरिकांना विनती कि आम्ही फसलो आहोत आता आपण फसू नका व अशी फसवणूक करणार्या कंपन्याना बाद करण्यासाठी शासनावर दडपण आणणे गरजेचे आहे.
cosmos bank booked this type of 2200 number of customers at chichwad branch.
मी पोलिस केस करणार आहे आपण मला मदत करावी जर आपल्या सोबत असा प्रकार झाला असेल तर मला संपर्क करावा . ७७९८८११५१२ .
विकास पाटील

Email. [email protected]
mobile 7798811512

Jayalalithaa sentenced to four years imprisonment in disproportionate assets case
Jayalalithaa, the AIADMK supremo now stands disqualified immediately from the Assembly and will have to step down as chief minister 
 

Tamil Nadu Chief Minister J Jayalalithaa on Saturday was sentenced to four year imprisonment and fined Rs100 crore in the 18-year-old disproportionate assets case. The verdict by a special court in Bangalore raises questions over her continuance on the post and the big question is who will head the government in the absence of Jayalalithaa. She ceases to be MLA and CM. She will go to jail tonight.

 

The conviction of the AIADMK supremo has come as a rude shock to the ruling party, casting a doubt over the 66 year-old leader’s political future ahead of the 2016 assembly polls.

 

Earlier in the day, Special Judge John Michael D'Cunha convicted Jayalalithaa in a case of owning assets to the tune Rs66.65 crore disproportionate to her known sources of income during 1991-96 when she became Tamil Nadu's chief minister for the first time. 
 
Jayalalithaa's close aide Sasikala Natarajan, her niece Ilavarasi and her nephew and the chief minister's disowned foster son Sudhakaran were also convicted. 
 
The verdict was delivered at a makeshift court in the Parappana Agrahara prison complex in the presence of Jayalalithaa and the other accused.
 
Soon after the court verdict, there were some cases of violent protests across Tamil Nadu and some parts of Karnataka. Several owners have closed their shops in Chennai with some of the private offices ‎asking their employees to leave early. Supporters of AIADMK pelted stones at the residences of BJP leader Subramanian Swamy and DMK chief M Karunanidhi following the verdict.
 
Jayalalithaa has earned the dubious distinction of becoming the first sitting Chief Minister in the country to be found guilty under the provisions of the Prevention of Corruption Act and faces the prospects of being disqualified as MLA and losing power.

While a pall of gloom descended at the AIADMK headquarters at Royapettah, with some angry workers burning effigies of DMK leaders, the archrivals celebrated Jayalalitha’s conviction with scores of DMK workers thronging the headquarters Arivalayam as well as Karunanidhi’s residence.

The special court’s verdict pronouncing their leader ’Amma’ (Mother, as she is addressed by supporters) guilty crushed the die-hard AIADMK supporters’ hope of her emerging unscathed in this case that was hanging over her head like the Damocles sword.

The case was transferred to Bangalore's Special Court in 2003 by the Supreme Court on a petition filed by DMK leader K Anbazhagan who had expressed doubts over conduct of fair trial with Jayalalithaa as Chief Minister. 
 
Appearing before the court four times, Jayalalithaa has answered 1,339 questions in closed door hearings during, which she has maintained that the case was "politically motivated" and "fabricated" at the instance of her rival DMK. 
 
The case was filed by Subramanian Swamy in 1996. She was arrested and jailed for some days after DMK came to power in the 1996 Tamil Nadu Assembly polls. 
 

She had to step down as Chief Minister in 2001 when Supreme Court observed that she cannot hold office, as she was earlier sentenced in two corruption cases in 2000, which, however, was set aside later.

Today’s verdict has come as a jolt to the ruling AIADMK as it had been enjoying a winning spree in all elections held since April 2011, when the party trounced DMK.

The party had put up a stellar performance in the Lok Sabha polls this year, winning 37 of the 39 states in the state, though its hopes of a pivot role in the Centre failed with the BJP mustering majority on its own.

However, there is no threat to the party government as AIADMK has a solid majority of 150 seats in the 234-member Assembly.

She had been acquitted in several other cases filed during the DMK regime.

After the apex court’s observation in 2001 that she cannot continue in office, Jayalalithaa had made her loyal aide and then not-so-known face O Panneerselvam as her successor to power.

After getting absolved of the charges in the Madras High Court, she had contested from Andipatti constituency and became the Chief Minister again in 2002.

Panneerselvam is also one of the names presently doing the rounds in AIADMK circles as one of the probables to take over as the next Chief Minister if Jayalalithaa has to resign.

The others being Transport Minister V Senthil Balaji and Electricity Minister Natham R Viswanathan and even former Chief Secretary and Consultant to the state government, Sheela Balakrishnan.

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COMMENTS

jaideep shirali

2 years ago

Amazing that we still have persons who support the corrupt, when to most citizens, corruption is this country's worst enemy. Jaya and other corrupt persons deserve the harshest punishment, not sympathy. The few crumbs thrown at the poor from government coffers came from the citizen's own pockets, not Jaya's. The 100 car official motorcades were also an insult to this country's poor. And just as the citizen cannot claim to be a "victim of political conspiracy", neither can the politician who is caught and sentenced. Whether we sentence any other politician is irrelevant, each corrupt politician should be treated as an enemy of this great nation and dealt with accordingly.

jaideep shirali

2 years ago

Amazing that we still have persons who support the corrupt, when to most citizens, corruption is this country's worst enemy. Jaya and other corrupt persons deserve the harshest punishment, not sympathy. The few crumbs thrown at the poor from government coffers came from the citizen's own pockets, not Jaya's. The 100 car official motorcades were also an insult to this country's poor. And just as the citizen cannot claim to be a "victim of political conspiracy", neither can the politician who is caught and sentenced. Whether we sentence any other politician is irrelevant, each corrupt politician should be treated as an enemy of this great nation and dealt with accordingly.

jaideep shirali

2 years ago

Amazing that we still have persons who support the corrupt, when to most citizens, corruption is this country's worst enemy. Jaya and other corrupt persons deserve the harshest punishment, not sympathy. The few crumbs thrown at the poor from government coffers came from the citizen's own pockets, not Jaya's. The 100 car official motorcades were also an insult to this country's poor. And just as the citizen cannot claim to be a "victim of political conspiracy", neither can the politician who is caught and sentenced. Whether we sentence any other politician is irrelevant, each corrupt politician should be treated as an enemy of this great nation and dealt with accordingly.

jaideep shirali

2 years ago

Amazing that we still have persons who support the corrupt, when to most citizens, corruption is this country's worst enemy. Jaya and other corrupt persons deserve the harshest punishment, not sympathy. The few crumbs thrown at the poor from government coffers came from the citizen's own pockets, not Jaya's. The 100 car official motorcades were also an insult to this country's poor. And just as the citizen cannot claim to be a "victim of political conspiracy", neither can the politician who is caught and sentenced. Whether we sentence any other politician is irrelevant, each corrupt politician should be treated as an enemy of this great nation and dealt with accordingly.

jaideep shirali

2 years ago

Amazing that we still have persons who support the corrupt, when to most citizens, corruption is this country's worst enemy. Jaya and other corrupt persons deserve the harshest punishment, not sympathy. The few crumbs thrown at the poor from government coffers came from the citizen's own pockets, not Jaya's. The 100 car official motorcades were also an insult to this country's poor. And just as the citizen cannot claim to be a "victim of political conspiracy", neither can the politician who is caught and sentenced. Whether we sentence any other politician is irrelevant, each corrupt politician should be treated as an enemy of this great nation and dealt with accordingly.

jaideep shirali

2 years ago

Amazing that we still have persons who support the corrupt, when to most citizens, corruption is this country's worst enemy. Jaya and other corrupt persons deserve the harshest punishment, not sympathy. The few crumbs thrown at the poor from government coffers came from the citizen's own pockets, not Jaya's. The 100 car official motorcades were also an insult to this country's poor. And just as the citizen cannot claim to be a "victim of political conspiracy", neither can the politician who is caught and sentenced. Whether we sentence any other politician is irrelevant, each corrupt politician should be treated as an enemy of this great nation and dealt with accordingly.

N Ramesh

2 years ago

Technically speaking, this is the only case in which Madam could have come out unscathed, by merely resorting to the legal tactics of 'admission of guilt', on account of which she would have merely paid some fine and penalty and thus avoided a harsh sentence !

But unfortunately she was wrongly and foolishly advised by a bunch of worthless Chartered Accountants and Senior Lawyers, including some so-called Legal Luminaries, who took a lot of money as fees from her all along and not only did a poor job but also misguided her all these years !

N Ramesh

REPLY

MOHAN

In Reply to N Ramesh 2 years ago

I agree !

Nifty, Sensex likely to rally – Weekly closing report
Nifty can rally till 8,100 as long as it does not go below the last week’s low of 7,841
 
The S&P BSE Sensex closed the week that ended on 26th September at 26,626 (down 464 points or 1.71%), while the NSE's CNX Nifty ended at 7,969 (down 153 points or 1.88%). Last week, we had mentioned that the Nifty may rally haltingly and it is likely that the index may cross 8,200 but may be brought down by selling.
 
As we had anticipated, the Indian market opened weak on Monday only to gather momentum by the end of the session, making the Nifty close in the positive for the fourth consecutive session. Nifty closed at 8,146 (up 25 points or 0.31%). One of the highlights of the day was the CBI telling a special court that it would not file further final reports for the time being in any coal blocks allocation scam case as the Supreme Court has restrained it from doing so.
 
The upmove came to a pause on Tuesday against what we anticipated on Monday. Nifty closed sharply at 8,018 (down 129 points or 1.58%). There was news of the Delhi government announcing up to 20% increase in circle rates. The circle rates are minimum rates below which a property cannot be registered. It forms the basis of stamp duty and registration charges for property.
 
The weakness on the bourse continued on Wednesday. Nifty closed at 8,002 (down 15 points or 0.19%). The Supreme Court scrapped all but four of the coal blocks allocated between 1993 and 2010, which the court had termed illegal earlier. The bench also directed the companies, which were allocated coal blocks but had not operationalised them, to pay compensation to the government for the loss of exchequer.
 
On Thursday, Nifty closed at 7,912 (down 91 points or 1.13%). The Cabinet Committee on Economic Affairs once again deferred a decision on revising gas prices. It has been deferred for a third time in view of next month's assembly elections in Maharashtra and Haryana.
 
Prime Minister Narendra Modi on Thursday launched the 'Make in India' campaign which is aimed at making the country a global manufacturing hub.
 
With the news on S&P raising the outlook for India on Friday, Nifty broke three days of negative move and closed at 7,969 (up 57 points or 0.72%). S&P raised the outlook for India to "BBB-minus" rating, back to "stable" from "negative". It also said it could raise India's rating if the growth in the economy reverted back to a real per capita gross domestic product of 5.5% per year, and if its fiscal, external and inflation metrics improve.
 
The Reserve Bank of India will undertake its fourth bi-monthly monetary policy review on 30 September 2014.
 
For the week, among the other indices on the NSE, the only top performer was FMCG (2%), while the worst two performers were Realty (9%) and Smallcap (7%).
 
Among the Nifty stocks, the top five gainers were ITC (3%); HCL Technologies (2%); ONGC (2%); Hindustan Unilever (2%) and Mahindra & Mahindra (1%), while the top five losers were Jindal Steel & Power (13%); BHEL (9%); PNB (9%); Tata Steel (7%) and Asian Paints (6%).
 
Of the 1,464 companies on the NSE, 197 companies closed in the green, 1,257 companies closed in the red while 10 companies closed flat.
 
Out of the 27 main sectors tracked by Moneylife, top five and the bottom five sectors for this week were:
 

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