GRIEVANCE REDRESSAL

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GRIEVANCE REDRESSAL

• THE TWO SIDES OF THE COIN
• PRESENTATION BY
• G V Rao
• 23rd Nov.2006

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Why claims settlement are important to insurers?

• Opportunity- Value addition product relations.
• Market growth no indicator of insurers progress.
• Low frequency at 6 and settlement 65 .
• 75 in courts and 40 beyond three years.
• Insurers record _at_ judicial forumswin/lose
• Credibility of insurers faith in insurance poor.

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ADRs available to consumers.

• Grievance redressal cells.
• Directorate of Public Grievances.
• Consumer forums.
• Ombudsmen.
• Arbitration mechanism.
• IRDA under section 64 U M.
• Civil courts
• MACT, Lok Adalat.

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Problems of consumers1.

• Principles of Utmost good faith Indemnity.
• Tariffs and 64 V B.
• Win-lose contractseach wary of other.
• Double standards _at_ buying claims making.
• Claims staff poorly qualified. Marketing key.
• Outsourced operations liability Quantum.
• Investigator appointment.

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Problems of consumers 2.

• Survey reports not made available.
• Poor performance of grievance cells.
• Brotherhood in staff.
• Poor corporate governance.
• Claim settlement not a differentiator yet.

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Problems of insurers.

• Self-denialno problems on claims exist.
• Audit Vigilance angle to all settlements.
• No punishments- delays or wrong decisions.
• Lost casesno lessons drawn.
• Almost all claimantsdishonest and greedy
• Attitudes of favor-dispensing.
• Premium, and not reputation matters.

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What should insurers do?-1.

• Accept there is a problem on claims.
• Involve Board in claims and grievances.
• Select train claims staff on professional
  competence mentor them.
• Provide a reference library to look up.
• Involve outside experts in Grievance Cells
• Let surveyors appoint investigators.

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What should insurers do?-2

• Provide survey reports to justify decisions.
• Have anti-fraud strategies in place.
• Learn from cases lost in judicial forums.
• Use uncontested court decrees, as binding
  precedents to apply.
• Delays or wrong decisions should be viewed more
  seriouslypull up staff.

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What should Courts do?

• Give directions too, and not only decisions.
• Consumer forums not to deal with insurance
  related claims. Public money.
• Insurers should set up self-funded Tribunals to
  deal with industry claims.
• IRDA involvement under 64 UM is available to
  aggrieved. IRDA to encourage.

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What ails insurers?

• Professional capabilities questionable.
• Legal thinking and training lacking.
• Bias and fear in taking decisions.
• Consult external experts, if in doubt.
• Learn from court decrees.
• Litigation is costlyinvolves reputation.

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Final word.

• Change needs initiatives reinvention.
• Priorities need to change.
• Insurance covers -up for renewal annually.
• Nothing is permanently lost.
• Pro-consumer attitude is needed.
• Core values and principles need to be stated and
  practiced.