General Insurance: K K Mishra

Last Updated: Fri, Sep 28, 2012 04:59 hrs

Recently, I had an issue with a general insurance company regarding my claim. Since, it is not resolved, whom should I approach? Can I file a complaint with the general insurance ombudsman? How many days will they take to resolve claim issues?
The complaint by an aggrieved person has to be in writing and addressed to the insurance ombudsman of the jurisdiction under the office of the insurer. The address and other details may be obtained from the Insurance Regulatory and Development Authority's (Irda) website. However, before lodging a complaint, keep in mind:

  • The complainant should have made a representation to the insurer named in the complaint and the insurer either should have rejected the complaint or the complainant should have not received any reply within a period of one month after the insurer has received his complaint or he is not satisfied with the reply of the insurer.
  • The complaint is not made later than one year after the insurer had replied.
  • The same complaint on the subject should not be pending before any court, consumer forum or arbitrator.

I am married with a five-year old daughter. My parents (aged 60 and 65) also stay with me. I am planning to buy health insurance as I don't have one. Should I buy a family floater plan or individual health covers? I am 35 and my wife is 32. Please advise.

An individual health cover for a family means each member of the family has his or her individual sum insured to claim under one health insurance plan. In other words, the cover is not shared with other members in the family. Also, sum insured chosen under individual health cover can be different for different members. If the main insured is taking a Rs 10 lakh cover, a spouse can chose a Rs 5 lakh cover and the child can choose a Rs 3 lakh cover, based on need.

On the other hand, in a family floater plan, the health insurance coverage amount is shared among all members covered. If the sum insured chosen is Rs 10 lakh, the entire family will be covered under that. As the cover is shared amongst all family members, the policy is relatively less expensive than individual health covers. However, if parents are included in the family floater, the policy can be expensive, as the premium for the full policy is calculated based on the eldest member's age. Therefore, it is advisable to buy a separate plan for parents. On buying a separate cover for parents, the proposer can avail of additional tax benefits under Section 80D for premiums paid up to Rs 20,000. We would suggest you opt for independent coverage for each family member, though it might cost marginally more than a family floater.

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