A consumer complaint against an insurance company is filed under the Consumer Protection Act 2019 when the insurer repudiates or unreasonably delays a claim, which amounts to a deficiency in service. A genuine dispute over what a policy clause means is different - there the commission reads the clause and decides the contract question rather than treating every refusal as a deficiency. The usual sequence is a written complaint to the insurer's grievance officer, and then either the insurance ombudsman or the consumer commission. The repudiation letter is the document the whole case is built around.
Repudiation or policy dispute
Not every refusal is a deficiency. Distinguish the two before you file:
- Deficiency - the insurer refuses a claim that the policy clearly covers, delays settlement beyond the time the law allows, short-pays without reason, or repudiates on a ground that does not exist.
- Policy dispute - the parties genuinely differ on the meaning of a clause, on whether an event falls within the cover, or on the amount payable. The commission still decides this, but the answer turns on reading the policy, not on a finding of bad service.
Read the repudiation letter carefully, and use a consumer complaint format before you file. It usually names the exact ground - non-disclosure, exclusion, delay in intimation, or want of the required documents - and that ground tells you what you have to answer.
The sequence: grievance officer, then ombudsman or commission
- Grievance officer. First lodge a written complaint with the insurer's grievance redressal officer and keep the acknowledgement and the reference number. This is mandatory before the ombudsman and expected before the commission.
- Ombudsman. The insurance ombudsman, under the Insurance Ombudsman Rules 2017, is free, quick and suited to smaller claims within its monetary limits. It is reached after the insurer fails to reply or the reply is unsatisfactory.
- Consumer commission. Suited to larger claims, to disputes needing evidence and, where you also seek compensation for mental agony and cost. Its order is enforced like a decree.
Do not run the same claim in two forums at once; choose the one that can give the relief you need and use the other in reserve.
Documents to attach
- the policy document and the schedule, showing the cover and its terms;
- the proposal form and the declarations you signed;
- the medical records and treatment papers for a health or life claim;
- the surveyor's report and the insurer's assessment for a property or motor claim (see our motor accident claims page for the accident-claim side);
- all claim correspondence, and the repudiation letter in particular;
- the grievance officer's reference and the reply, or proof that none came;
- a short affidavit and the fee prescribed for the value of the claim.
Reliefs
The commission can direct payment of the sum assured or the claim amount, with interest for the delay, make good the amount of any short-payment, award compensation for mental agony and litigation cost, and direct that a particular practice not be repeated. Quantify each head and support it with the policy and the settlement papers.
Timelines and limitation
A consumer complaint must be filed within two years from the date the cause of action arises, under Section 69 of the Consumer Protection Act 2019. The cause of action usually arises when the insurer repudiates the claim or delays its settlement, so the repudiation letter and the grievance reply fix your starting point. Where a life policy is repudiated, note that the Insurance Act 1938 restricts an insurer from calling a policy in question on the ground of fraud or non-disclosure after the period the Act allows; rely on that only through the documents, not as a bare assertion.
Common defences and how to answer them
- Non-disclosure or misrepresentation. The insurer says you failed to disclose a material fact in the proposal. Answer with the proposal form itself: show what the question asked, what you answered, and whether the fact was material to the risk. Where the insurer had the information from another source or did its own medical examination, say so and attach the record.
- Delay in intimation. Show the date of the event, the reason for any delay, and why the delay did not prejudice the insurer. A delay alone does not always defeat a genuine claim.
- Exclusion clause. Ask for the clause worded as it appears in the policy and check that it actually covers the event. An ambiguous exclusion is read against the insurer that drafted it.
- Warranty or condition breach. Where the insurer alleges a breach of a condition, show performance or a valid excuse, and point to the absence of loss caused by any breach.
Common questions
Must I go to the grievance officer before filing?
For the ombudsman, yes - the rules require that the matter was first raised with the insurer. For the commission it is not an absolute bar, but a prior written complaint proves the insurer had notice and refused to cure the defect. Always raise the first complaint in writing and keep the reference.
The insurer paid only part of my claim. Can I complain?
Yes. A short-payment that is not explained by the policy is a deficiency. Ask for the basis of the assessment - the surveyor's report and the calculation - and plead the difference between the amount the policy warrants and the amount paid, with evidence of the loss.
How do I answer the charge of non-disclosure?
Go back to the proposal form. Identify the exact question and your answer, and test whether the fact was material and whether the insurer was misled. If the insurer obtained its own medical reports or had the facts elsewhere, that weakens the defence. Keep the medical and treatment records that show the true position.
Can I claim compensation beyond the policy amount?
Yes, you may seek interest for the delay, compensation for mental agony and litigation cost, in addition to the claim amount, where you plead and prove them. These are separate heads, so claim each with its own basis rather than folding them into the sum assured. Contact us to review the repudiation.
FileX Advocates & Legal Consultants, Kolkata, drafts and files these matters before the Calcutta High Court, City Civil and Sessions courts, magistrate, family, consumer and tribunal forums. Call +91 7439811422 or WhatsApp us for a free first consultation.