Non-Compliance of Award of Insurance OMBUDSMAN.

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• JI ••• MNII ~ Hrth.f 'dtm ~f.hu~cfi 3ffi ~cfiltt ~ INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA Ref: IRDAI/CAD/CIR/MISC/063/03/2016 Date: 31-03-2016 To CEOs of All Insurers. Re: Non-Compliance of Award of Insurance OMBUDSMAN. IRDAI has been receiving communications from certain Ombudsman bringing to its notice the inordinate delay on the part of the Insurance Companies to implement the orders/ awards of the Insurance Ombudsman. Similar complaints have also been received from the aggrieved Policy Holders on the above issue. Considering the seriousness of the issue, IRDAI in consultation with Legal Department updated the earlier circular Ref: CAD/ lnsu.Omb/ 10-11 dated 23.11.2010 and issued a circular Ref: IRDAI/ Cir/Misc/194/11/ 2015 dated 03-11-2015 advising the Insurers as follows: 1. Orders of Judicial/Quasi Judicial bodies should be complied by the Insurer within the time frame stipulated in the order or award and in cases where time frame is not specified in the order/award, the order/award should be complied within 60 days of the receipt of the order/ award by the Insurer and 2. In cases where the Insurer prefers an appeal against the order of the Judicial/Quasi Judicial body, such appeal against the order should be preferred within the stipulated time limit as per the rules applicable. 3. The Complainant should be informed in the matter accordingly. In view of the above and in order to monitor the above aspect, You are advised to submit the following data for review and to place before the competent authority: 1. The List of Ombudsman awards that are pending for compliance for the last 3 years ie., 2013-14,2014-15 and 2015-16 (Yly.) by 7h of April, 2016 in the attached format. 2. Monthly statement on the status of Ombudsman cases and compliance of its awards by the Insurers, as per the format enclosed, from April 2016 onwards to reach us before lOu, of the subsequent month. 3. Monthly statement on the status of court cases as per the format attached to be submitted every month from April, 2016 onwards to reach us before 10th of the subsequent month. ~t~ :so,al of the Competent Autho,ity. T. S. Naik, Joint Director, Consumer Affairs Department. 1.f~'l'I ~.mi~.~. ~-500 004. ~ ((): 91·040-23381100, ~: 91-040-6682 3334 i-~: irda@1rda.gov.in ~ : www.irda.gov.1n Parisharam Bhavan, 3rd Floor, Basheer Bagh, Hyderabad-500 004. India. Ph. 91-040-2338 1100, Fax: 91-040-6682 3334 E-mail : 1rda01rda.gov.m Web.: www.1rda.gov.1n ANALYSIS OF OMBUDSMAN AWARDS NAME OF THE INSURER Awards/Cases Opening Balance as No. of cases for pending for the beginning of the Received during the which Appeal compliance by YEAR year year preferred Insurers A B C D (A +B -C) No. Amount No. Amount No. Amount No. Amount 2013-14 2014-15 2015-16 -- •• Reasons for non compliance with regard to each of the awards mentioned at E & F to be provided separately Name of the GRO Remarks of the GRO 7 L, l Duration w ise data of pending Awards E F M ore than 60 days Less than 60 days No. Amount No. Amount ~ -~ ANALYSIS OF OMBUDSMAN AWARDS NAME OF THE INSURER Opening Balance as No. of cases for No. of Awards the beginning of the Received during the which Appeal complied with by the Month Month• Month preferred Insurers A B C D No. Amount No. Amount No. Amount No. Amount 2013-14 2014-15 2015-16 2016-17 Total *Total No. of Cases pending as at the end of previous month pertaining to the respective years. •• Columns D,F,G &Hare to be 'Jl99!" year wise. Awards/Cases pending for compliance by Insurers F =A+B-(C+D) No Amount # Reasons for non compliance with regard to each of the awards mentioned at G & H to be provided separately Name of the GRO Remarks of the GRO ttL, .... , l Duration wise data of pending Awards# G H More than 60 days Less than 60 days No. Amount No. Amount ~ Statement of Grievance Disposals in Consumer Courts (To be submitted every Month to Consumer Affairs Department - IRDAI) Insurers Name Registration Number Date of Hegistration: No. Of Cases Resolved / Settled Total C1 Additions Cases registc• cases. Case S.No Particulars Opening during the In fa vour of In favour dismissed pending upto cid of as on ciurinp t Balance as period Policyholder I insurer finan( 1 on Rejected - - yea' - 1 District Forums I 2 State Commissions _j 3 National Commission 4 Civil Court 5 High Court Total --