Lok Sabha Question No. 1088 (UNSTARRED), answered on 2016-04-29
Subject: Settlement of Insurance Claims
Ministry: FINANCE
Asked by: RAMESH POKHRIYAL NISHANK, BHARAT SINGH, VIJAY KUMAR HANSDAK

## GOVERNMENT OF INDIA MINISTRY OF FINANCE DEPARTMENT OF FINANCIAL SERVICES

## LOK SABHA UNSTARRED QUESTION NO. 1088

TO BE ANSWERED ON 29 th  April, 2016 / Vaisakha 9, 1938 (Saka)

## Settlement of Insurance Claims

†1088. DR. RAMESH POKHRIYAL 'NISHANK":              SHRI BHARAT SINGH: SHRI VIJAY KUMAR HANSDAK:

Will the Minister of FINANCE be pleased to state:

- (a) the  details  of  the  measures  taken  by  the  Government  to  make  the  process  relating  to  the proper settlement of insurance claims more simple, transparent and time bound;
- (b) whether a large number of complaints of financial irregularities and settlement of claims has been received against the insurance companies in the last one year; and
- (c) if so, the details thereof along with the number of complaints disposed off, during this period company-wise?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF FINANCE (SHRI JAYANT SINHA)

(a)  to  (c):  As  per  the  information  furnished  by  Insurance  Regulatory  and  Development  Authority  of India  (IRDAI),  the  Authority  has  notified  IRDA  (Protection  of  Policyholders)  Interest  Regulations, 2002.  Regulation  8  and  9  of  the  said  Regulations  mandates  the  procedures  and  timelines  to  be followed for settlement of claims in respect of Life and Non Life (including Health) insurance policies respectively.   In addition, Regulation 8 of the IRDA (Health Insurance) Regulations, 2013 prescribes norms for settlement of claims in respect of Health Insurance policies.

Further, the Authority conducts focused onsite inspection in case any grave irregularity is noticed in the  claim  settlement  by  the  insurer  or  during  the  course  of  redressing  the  grievance  of  the policyholders  related  to  the  claim  settlement.  Based  on  the  investigation  and  follow  up,  necessary regulatory and corrective actions are initiated.

The IRDAI has also set up Integrated Grievance Management System (IGMS), an online consumer complaints  registration  system,  wherein  Policyholders  can  register  their  complaints  with  their insurance company and track the progress of complaint resolution. IRDAI monitors the complaints and their progress in real-time through IGMS. Under IGMS, IRDAI plays a facilitative role in resolution of  policyholder  grievances.  IGMS  also  acts  as  central  repository  of  complaints  of  the  insurance industry.

The Central Government has framed Redressal of Public Grievances Rules (RPG Rules), 1998 to resolve  complaints  related  to  settlement  of  claims  on  the  part  of  insurance  companies  in  cost effective, efficient and impartial manner through the mechanism of Insurance Ombudsman.

The status of the claim related complaints registered on IGMS during the year 2015-16 against life & non-life insurance companies is given in Annexure I & II respectively. These complaints include all servicing  related  matters  pertain  to  survival  claims,  death  claims  and  non  life  claims  as  well  as repudiations and partial repudiations of claims.

***************

| Claim Related Complaints in IGMS for FY 2015-16 (Life)   | Claim Related Complaints in IGMS for FY 2015-16 (Life)   | Claim Related Complaints in IGMS for FY 2015-16 (Life)   | Claim Related Complaints in IGMS for FY 2015-16 (Life)   | Claim Related Complaints in IGMS for FY 2015-16 (Life)   |
|----------------------------------------------------------|----------------------------------------------------------|----------------------------------------------------------|----------------------------------------------------------|----------------------------------------------------------|
| S.No                                                     | Insurer Name                                             | Received                                                 | Disposed                                                 | Pending                                                  |
| 1                                                        | AEGON Religare Life Insurance Company Limited            | 377                                                      | 372                                                      | 5                                                        |
| 2                                                        | Aviva Life Insurance Company India Limited               | 132                                                      | 132                                                      | 0                                                        |
| 3                                                        | Bajaj Allianz Life Insurance Company Ltd.                | 923                                                      | 923                                                      | 0                                                        |
| 4                                                        | Bharti-Axa Life Insurance Company Ltd.                   | 128                                                      | 128                                                      | 0                                                        |
| 5                                                        | Birla SunLife Insurance Company Limited                  | 959                                                      | 959                                                      | 0                                                        |
| 6                                                        | Canara HSBC Oriental Bank of Commerce Life Ins.          | 427                                                      | 427                                                      | 0                                                        |
| 7                                                        | DHFL Pramerica Life Insurance Co. Ltd.                   | 48                                                       | 48                                                       | 0                                                        |
| 8                                                        | Edelweiss Tokio Life Insurance                           | 3                                                        | 2                                                        | 1                                                        |
| 9                                                        | Exide Life Insurance Company Limited                     | 1068                                                     | 1068                                                     | 0                                                        |
| 10                                                       | Future Generali India Life Insurance Company Ltd.        | 226                                                      | 226                                                      | 0                                                        |
| 11                                                       | HDFC Standard Life Insurance Co. Ltd.                    | 661                                                      | 661                                                      | 0                                                        |
| 12                                                       | ICICI Prudential Life Insurance Company Ltd              | 423                                                      | 423                                                      | 0                                                        |
| 13                                                       | IDBI Federal Life Insurance Co Ltd.                      | 50                                                       | 50                                                       | 0                                                        |
| 14                                                       | IndiaFirst Life Insurance Company Limited                | 248                                                      | 242                                                      | 6                                                        |
| 15                                                       | Kotak Mahindra Old Mutual Life Insurance Ltd.            | 155                                                      | 141                                                      | 14                                                       |
| 16                                                       | Life Insurance Corporation of India                      | 13588                                                    | 13588                                                    | 0                                                        |
| 17                                                       | Max Life Insurance Company Limited                       | 1035                                                     | 1035                                                     | 0                                                        |
| 18                                                       | PNB MetLife India Insurance Company Ltd.                 | 526                                                      | 521                                                      | 5                                                        |
| 19                                                       | Reliance Life Insurance Company Limited                  | 1576                                                     | 1542                                                     | 34                                                       |
| 20                                                       | Sahara India Life Insurance Co. Ltd.                     | 26                                                       | 26                                                       | 0                                                        |
| 21                                                       | SBI Life Insurance Co. Ltd.                              | 1116                                                     | 1116                                                     | 0                                                        |
| 22                                                       | Shriram Life Insurance Company Ltd.                      | 44                                                       | 44                                                       | 0                                                        |
| 23                                                       | Star Union Dai-ichi Life Insurance Company Limited       | 310                                                      | 303                                                      | 7                                                        |
| 24                                                       | Tata AIA Life Insurance Company Ltd.                     | 700                                                      | 699                                                      | 1                                                        |
| Grand Total                                              |                                                          |                                                          | 24676                                                    | 73                                                       |
|                                                          |                                                          | 24749                                                    |                                                          |                                                          |

Annexure II referred to in reply to Lok Sabha Un-Starred Question Number 1088 for 29.04.2016

Claim Related Complaints in IGMS for FY 2015-16 (Non Life)

| S.No                                                  | Insurer Name Received                      |   Disposed |   Pending |
|-------------------------------------------------------|--------------------------------------------|------------|-----------|
| 1                                                     | Apollo Munich Health Insurance Co Ltd. 479 |        477 |         2 |
| 2 Bajaj Allianz General Insurance                     | Company Ltd. 435                           |        415 |        20 |
| 3 Bharti AXA General Insurance Company Limited        | 2112                                       |       2104 |         8 |
| 4 Cholamandalam MS General Insurance Company Ltd.     | 741                                        |        729 |        12 |
| 5 CignaTTK Health Insurance Company Limited           | 25                                         |         25 |         0 |
| 6 Export Credit Guarantee Corporation of India Ltd.   | 4                                          |          0 |         4 |
| 7 Future Generali India Insurance Company limited     | 1980                                       |       1980 |         0 |
| 8 HDFC Ergo General Insurance Company Ltd.            | 1592                                       |       1579 |        13 |
| 9 ICICI Lombard General Insurance Company Limited     | 1233                                       |       1205 |        28 |
| 10 IFFCO TOKIO General Insurance Co. Ltd.             | 759                                        |        758 |         1 |
| 11 L And T General Insurance Company Limited          | 100                                        |        100 |         0 |
| 12 Liberty Videocon General Insurance Company Limited | 391                                        |        390 |         1 |
| 13 Magma HDI General Insurance Co Ltd.                | 96                                         |         95 |         1 |
| 14 Max Bupa Health Insurance Company Limited          | 330                                        |        330 |         0 |
| 15 National Insurance Company Limited                 | 2876                                       |       2799 |        77 |
| 16 Reliance General Insurance Co Ltd.                 | 767                                        |        751 |        16 |
| 17 Religare Health Insurance Company Limited          | 338                                        |        334 |         4 |
| 18 Royal Sundaram Alliance Insurance Company Limited  | 893                                        |        884 |         9 |
| 19 SBI General Insurance Co. Ltd.                     | 465                                        |        434 |        31 |
| 20 Shriram General Insurance Co. Ltd.                 | 85                                         |         85 |         0 |
| 21 Star Health And Allied Insurance Company Limited   | 1634                                       |       1617 |        17 |
| 22 TATA AIG General Insurance Company Ltd.            | 981                                        |        981 |         0 |
| 23 The New India Assurance Co. Ltd.                   | 2747                                       |       2646 |       101 |
| 24 The Oriental Insurance Company Ltd.                | 1514                                       |       1446 |        68 |
| 25 United India Insurance Company Limited             | 3581                                       |       3568 |        13 |
| 26 Universal Sompo General Insurance Company Limited  | 322                                        |        322 |         0 |
| Grand Total                                           | 26480                                      |      26054 |       426 |