The policy was mis-sold to me. Can I complain, and to whom?

Yes. A complaint about how a policy was sold is a grievance like any other, and insurers and their distribution channels, such as agents and other intermediaries, are responsible for how they sell. Complain in writing to the insurer first; if that does not resolve it, Bima Bharosa takes complaints against intermediaries too, and the Insurance Ombudsman hears some sales complaints, such as a policy that does not match your proposal form. If the policy is new, check first whether its free-look period is still running.

IRDAI's definition of a complaint covers dissatisfaction with the solicitation, sale or purchase of a policy, not only with claims, and a 'complainant' includes a prospect: someone who was being sold a policy. IRDAI's master circular also makes insurers and distribution channels, which include agents and other insurance intermediaries, responsible for the solicitation process and their conduct of business.^{[1, 2]}

What a mis-selling complaint can be about

• You were told the policy had a benefit, a return or a feature that the policy document does not contain.
• You asked for one kind of cover and were sold another, or a savings product was presented as something it is not.
• The proposal form was filled in by someone else, with details you did not give.
• The policy issued does not match what you applied for, or you paid a premium and no policy came.

Who to complain to

1. 1

   Check the free-look period

   Life policies and new individual health policies of a year or more carry a free-look period of 30 days from the day you received the policy document. If you disagree with the terms and have made no claim, you can return the policy in that period, stating your reasons; the request must be processed and the premium refunded within 7 days, less the limited deductions the Regulations allow.^[3]

2. 2

   Write to the insurer

   Even if an agent, a broker or another intermediary sold you the policy, you can complain to the insurer, to the distribution channel, or to both. Put it in writing and keep the acknowledgement.^[2]

3. 3

   Bima Bharosa

   IRDAI's portal takes complaints against an insurance company, an insurance intermediary (such as an agent, corporate agent, broker or web aggregator) or an unregistered entity. Neither the insurer nor the seller may discourage you from complaining to IRDAI.^{[4, 1]}

4. 4

   The Insurance Ombudsman

   The Ombudsman's grounds include misrepresentation of policy terms, a policy that does not conform to the proposal form, premium disputes and a policy not issued after the premium was paid, and the Rules cover complaints against insurance brokers as well as insurers. Whether or not you used Bima Bharosa, its usual conditions apply: a written complaint to the insurer first, which the insurer has rejected, answered unsatisfactorily or not answered within one month of receiving it, and filing within one year.^[5]

Evidence that helps

• What you were shown: The brochure, benefit illustration or quote you were given before you bought.
• What you were told: Messages and emails from the seller, and any call recordings you already have.
• What you signed: A copy of the proposal form. See how to get a copy of the proposal form.
• What you got: The policy document and any summary or information sheet that came with it.
• What you paid: Premium receipts and bank statements showing who was paid, and when.

ClaimAssure is an independent private platform. It is not an insurer, IRDAI, Bima Bharosa or the Insurance Ombudsman, it never files anything on your behalf, and it cannot promise any outcome. What it does is read your documents and show you what they say.

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