Q. Is there any time limit for insurance companies to settle death claims in life insurance policies and health insurance claims? If the insurance firm doesn't follow the policyholder, is the policyholder entitled to any compensation?

Anita Kulkarni, Vasai

A. As per Insurance Regulatory and Development Authority (IRDA) regulations, all insurance claims are expected to be settled expeditiously. The IRDA (Protection of Policyholders’ Interests) Regulation 2017 stipulates that a death claim under a life insurance policy shall be settled (either acceptance or rejection or part-acceptance) within 30 days from the date of receipt of all relevant papers and required clarifications. However, where the circumstances of a claim require an investigation in the opinion of the insurance company, it shall initiate the same at the earliest and complete expeditiously and in any case not later than 90 days from the date of receipt of the claim intimation and the claim shall be settled within 30 days thereafter.

Thus, in short, normal death claims under a life insurance policy are required to be settled within 30 days, and claims where further investigation is required have to be settled in 90 + 30 = 120 days. In respect of the health insurance claims, the same are normally required to be settled within 30 days from the date of receipt of all relevant papers and required clarifications. However, where investigation is required it shall initiate the same at the earliest and complete such investigation in not later than 45 days from the date of receipt of the claim intimation and the claim shall be settled within 30 days thereafter.

In short, normal Health Insurance claims are required to be settled within 30 days, and claims where further investigation is required have to be settled in 45 + 30 = 75 days. In case there is a delay on the part of the Insurance company the insurance company is required to pay interest at the rate which is 2 % more than the bank rate on the amount payable.

Q. I filed an insurance claim complaint in the consumer court in January 2024. However, I find that things are moving very slowly there, and may take a couple of years before I get the order. In such a case, can I withdraw this complaint from the consumer court and file it before the insurance ombudsman and is there any fee to be paid before the insurance ombudsman?

Vikas Palande, Dahisar

A. Yes, you can withdraw your pending complaint from the consumer court with the permission of the bench of the Consumer Commission and then file your complaint before the insurance ombudsman. However, you must take care to see that while filing the complaint you are well within the time limit. The complaint is required to be filed within one year from the date the insurance firm has informed you of its rejection of the claim or part-settlement of your claim. Although delay in filing a complaint may be condoned by the ombudsman, there has to be a satisfactory reason for your not filing the same within one year. Make sure that you are within the limit of one year and then only think of applying for withdrawal from the consumer court. There is no fee payable for filing a complaint before the insurance ombudsman.

Advocate Shirish V Deshpande is chairman of Mumbai Grahak Panchayat. Queries can be sent to him by email: shirish50@yahoo.com