In an interview with MintGenie, Arora said that one of the common issues where most policyholders often lag is their inability to inform the insurer promptly when an incident covered by the policy occurs. Additionally, providing incomplete documentation to support their claims is another issue common among policyholders.
Edited Excerpts:
Applications for insurance grievance redressals are common. Do you attribute these complaints to a lack of understanding about insurance? How do you think financial literacy can help solve this problem?
Most grievances stem from the applicant’s inability to comprehend certain terms or clauses in their insurance policy. While applying for the insurance they are not filing the proposal form on their own and this leads to non-disclosure of certain critical financial and pre-existing conditions. Complex technical terms and jargon further amplify the confusion among potential policy buyers, ultimately leading to dissatisfaction with the policy or its scope of coverage.
However, financial literacy can help tackle common challenges effectively. Individuals possessing basic financial knowledge are more adept at understanding their insurance needs and requirements, enabling them to pick a more suitable insurance. Their knowledge further helps them compare different insurance products and their features. Their insights can empower them to ensure their chosen insurance policy aligns with their needs and requirements. This is required both at the seller level and for the prospective insurance buyers.
What is the first thing that the insured must know before seeking a claim against the policy bought?
Before filing an insurance claim, individuals must confirm whether a specific clause or incident is covered by their policy or not. Subsequently, they should check the requisites, especially the essential documentation and the claim filing process.
Having all the details in place would allow them to support their claim application and streamline the verification process. We have developed the entire process in our app Polifyx which can guide the customer through the health claim filing process. This will also be useful to understand the documents that are mandated for submission for the approval of the claim.
More importantly, individuals must convey their intention of raising a claim to their insurer at the earliest to initiate the verification process. Timely communication lowers the risk of getting a claim rejected and helps policyholders access the required assistance in due time.
The Insurance Samadhan Grievance Redressal Portal is at the heart of your core service. Could you elaborate on the process users must follow to raise and redress their grievances? Which feature sets the platform apart from other grievance redressal mechanisms?
Individuals can easily get in touch with us through our website or the Polifyx mobile app. By simply registering an online complaint, consumers can convey their insurance-related grievances to us. Based on the nature of the complaint, our industry experts will contact them and offer them the most suitable advice to tackle the situation.
To register a complaint through the Insurance Samadhan website, individuals must provide a few basic information, such as their name, email ID, phone number, policy type, and the nature of the complaint. Once the complaint is registered, our representative contacts them and walks them through the process.
On the other hand, through our Polifyx app, individuals can not only raise a complaint but also manage their insurance policies more effectively. The smart app is designed keeping in mind the user requirements and serves as a hub for everything related to insurance. Typically, the app helps users store their policy details and claim history. It also enables them to track and manage their case developments through the app’s interactive dashboard.
Individuals who do not feel comfortable with either way can connect over a call or through our WhatsApp number, shared on our website. In my opinion, our user-friendly app design, comprehensive services, and quick response time set our platform apart from other grievance redressal mechanisms.
Please provide some insights into the categories of insurance claims your grievance redressal portal helps to settle.
We specialize in resolving grievances related to life insurance, health insurance, and general insurance. We focus on providing policyholders with the timely assistance they need to overcome challenges in insurance claim settlements. We also help them settle grievances related to insurance mis-selling, fraud, and settlement delays in India. Through our timely and unbiased advice, we help policyholders navigate the intricacies of their policy and take necessary steps to get concerns resolved. So far, our platform has resolved more than 14.5k consumer grievances, and over 5000 cases are in progress.
While addressing queries on insurance claims, where do you think people fail the most?
One of the common issues where most policyholders often lag is their inability to inform the insurer promptly when an incident covered by the policy occurs. Additionally, providing incomplete documentation to support their claims is another issue common among policyholders. This inability to provide complete and accurate documentation is often the primary reason behind their claim rejection.
Similarly, many policy buyers tend to hide their pre-existing health conditions when purchasing insurance. This habit leads to complications during claim verification when the insurer finds out about the undeclared condition. This is why we always urge consumers to remain transparent in their approach toward insurance and discourage them from withholding information that could potentially hamper their claim approval in the future.
Many Indians are not adequately insured. What would be your advice to people now gradually inching towards buying insurance?
I would recommend they identify their financial standing first and then proceed to assess their coverage needs, especially, what they deem adequate to meet their future financial obligations. For this to be effective, they must understand the purpose of insurance and the merit of different coverages. Next, they must research and compare insurance products, policy quotes, and features to understand both their scope and limitations properly. This knowledge would allow them to make an informed choice and help ensure their insurance policy aligns with all their requirements. More importantly, individuals must carefully review the fine print of the policy documents and read the claim clauses to understand if the insurance would provide them with the required assistance in times of need.
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Published: 02 Feb 2024, 09:45 AM IST