Customer Service - Regulatory View: by PC James Executive Director, IRDA
Customer Service - Regulatory View: by PC James Executive Director, IRDA
Customer Service - Regulatory View: by PC James Executive Director, IRDA
CHALLENGING ENVIRONMENT
Regulatory Mission, Competition, International Benchmarks, Convergence of Institutions, Instruments, Intermediaries , Disintermediation and Reintermediation
Insurance Industry
Mission of IRDA To protect the interests of the policyholders, to regulate, promote and ensure orderly growth of the insurance industry and for matters connected therewith or incidental thereto.
PROTECTION
ESTABLISH A REGULATORY FRAMEWORK TO PROVIDE ADEQUATE PROTECTION TO CONSUMERS
PROMOTION
Provide a favourable climate for product development/intermediation and healthy growth of insurance A reliable and stable market Freedom of entrepreneurial spirit * Balance between degree of prudential regulation and degree of freedom
*
COMPETITIVE NEUTRALITY
*
SOURCES OF REGULATIONS
*
Laws / Statutes
- Government
- Regulations - Guidelines - Industry - Corporate Governance
LAW
MAKES GENERAL FRAMEWORK FOR THE INDUSTRY EG. INSURANCE ACT 1938 IRDA ACT 1999 REGULATOR Issues specific rules & regulations Responsibility for enforcement
JUDICIARY
*
Decide on suits
INSURANCE POLICY FILE & USE - policy to confirm to requirements imposed by statute/regulation - policy to be consistent, not ambiguous, misleading, unfair or inequitable - the benefits provided are reasonable in relation to the premium charged
DESIRABLE REQUIREMENTS
Standardisation of clauses Simplification of terms & coverages Full disclosure Avoidance of misleading/confusing clauses Definitions of terms List of Policy Prohibitions including list of permissible exclusions
SELLING METHODS
LICENSING OF AGENTS / INTERMEDIARIES
SURVEYORS TPAS
ADVERTISING
POLICYHOLDER PROTECTION REGULATIONS POINT OF SALE PROSPECTUS PROVIDE ALL MATERIAL INFORM ATION TO DECIDE THE BEST COVER FOLLOW CODE OF CONDUCT PROPOSAL OF INSURANCE GRIEVANCE REDRESSAL PROCEEDURE MATTERS TO BE STATED IN POLICY CLAIMS PROCEEDURE POLICYHOLDER SERVICING DUTY OF INSURED
INSURANCE OMBUDSMAN
INSURANCE OMBUDSMAN EXISTS FOR SPEEDY, CONVENIENT REDRESSAL OF GRIEVANCES OF INSURED THAT TOO AT MINIMUM COSTS. OMBUDSMAN CAN DEAL WITH PERSONAL LINES CLAIMS (INCLUDING HEALTH INSURANCE) UP TO RS.20 LACS.
OMI 15%
OTHERS 4%
FIRE MARINE 6% 2%
MOTOR 25%
HEALTH 48%
Individuals 87%
NON SETTLEMENT / DELAY IN SETTLEMENT OF CLAIM REPUDIATION / PARTIAL SETTLEMENT OF CLAIM POLICY ISSUES OTHER REASONS
IRDAS CONCERNS
PROHIBITED SALES PRACTICES AND UNETHICAL INTERMEDIATION MISLEADING ADVERTISEMENTS
CONSUMER ACCESS
THANK YOU