Non-Compliance of Award of Insurance… — 01 Apr 2016

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Non-Compliance of Award of Insurance… — 01 Apr 2016 | IRDAI circular · Complied AI

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भारतीय बीमा विनियामक और विकास प्राधिकरण INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA

Ref: IRDAI/CAD/CIR/MISC/063/03/2016

Date: 31-03-2016

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/Insu.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:

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
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.
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:

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 $7^{\text{th}}$ of April, 2016 in the attached format.
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 $10^{\text{th}}$ of the subsequent month.
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 $10^{\text{th}}$ of the subsequent month.

This has the approval of the Competent Authority.

T. S. Naik,
Joint Director,
Consumer Affairs Department.

परिश्रम भवन, तीसरा तल, बशीरबाग, हैदराबाद-500 004. भारत
(C): 91-040-2338 1100, फैक्स: 91-040-6682 3334
ई-मेल: irda@irda.gov.in वेब: www.irda.gov.in
Parisharam Bhavan, 3rd Floor, Basheer Bagh, Hyderabad-500 004. India.
Ph.: 91-040-2338 1100, Fax: 91-040-6682 3334
E-mail : irda@irda.gov.in Web.: www.irda.gov.in

ANALYSIS OF OMBUDSMAN AWARDS

NAME OF THE INSURER

YEAR	Opening Balance as the beginning of the year A		Received during the year B		No. of cases for which Appeal preferred C		Awards/Cases pending for compliance by Insurers D (A +B -C)		Duration wise data of pending Awards
	Opening Balance as the beginning of the year A		Received during the year B		No. of cases for which Appeal preferred C		Awards/Cases pending for compliance by Insurers D (A +B -C)		E More than 60 days		F Less than 60 days
	No.	Amount	No.	Amount	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

ANALYSIS OF OMBUDSMAN AWARDS

NAME OF THE INSURER

Month	Opening Balance as the beginning of the Month * A		Received during the Month B		No. of cases for which Appeal preferred C		No. of Awards complied with by the Insurers D		Awards/Cases pending for compliance by Insurers F =A+B-(C+D)		Duration wise data of pending Awards#
	Opening Balance as the beginning of the Month * A		Received during the Month B		No. of cases for which Appeal preferred C		No. of Awards complied with by the Insurers D				G More than 60 days		H Less than 60 days
	No.	Amount	No.	Amount	No.	Amount	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 & H are to be year wise.

Reasons for non compliance with regard to each of the awards mentioned at G & H to be provided separately

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Non-Compliance of Award of Insurance OMBUDSMAN.

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Reasons for non compliance with regard to each of the awards mentioned at G & H to be provided separately

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