In case the insured/policyholder has any grievance regarding services, products, or processes of ECGC Health Insurance Company, they may approach the grievance redressal cell. This detailed FAQ will mention all the steps involved as well as the contact details.

Complaints that would require immediate reporting to the Compliance Department include complaints pertaining to the Sales conduct of agents, brokers, and other sales intermediaries. These complaints could be regarding any of the following:

• Mis-selling
• Mis-representation
• Rebating
• Misappropriation of funds
• Fraud
• Forgery
• Lack of service
• Theft
• Commission schemes / sharing
• Fictitious policies
• Employee fraud
• Vendor fraud
• Administration, control, coordination, and reporting of customer complaints received through regulatory agencies.
• Allegations of financial irregularities by any person who has a responsibility within the company and that involve money, credit, or any other property of the company or its clients
• Any complaint where there is a stated or implied threat of litigation
• Any other matter as may be defined by Compliance from time to time

Step 1

The insured can register a complaint through the following modes:

• Customer Support: 1800 22 4500
• Complaint Registry: http://119.226.14.43/ecgc/grievance/login.aspx
• Customer also has the option to contact the ECGC Health Insurance company branch directly for any further clarification

The company's service strategy is to enable the customer to avail the services through multiple avenues. The company shall have a four-tiered Grievance Redressal machinery with a designated Grievance Officer at each level:

• Branch Manager is the branch-level Grievance Officer
• Regional Manager is the regional-level Grievance Officer
• General Manager is the head-officer-level Grievance Officer

The principal function of the branch-level Grievance Officer would be to redress the grievance complaints received by the branch. It is expected that the grievance officers at the regional level and head office level to play a more proactive role in not only redressing grievances but in minimizing incidences too.

The Apex Customer Grievance Committee (ACGC) at located at the Head Office. This is a committee constituted under the chairmanship of the Chairman cum Managing Director and comprising of such members as may be provided from time to time.

The Grievance Redressal procedure/system: IRDAI stipulates a maximum time limit of 15 days for the disposal of a customer grievance.

In case you are not satisfied with the information provided by the insurance company or if there is no response from the insurance company, then you may further contact the Grievance Redressal Cell of the Consumer Affairs Department of IRDA or the Insurance Ombudsman.

IRDA Grievance Details

• IRDA Grievance toll-free number: 155255
• Fax number : 91 40 6678 9768
• Email ID: complaints@irda.gov.in
• You can also register your complaint online at http://igms.irda.gov.in
• Address for communication for complaints by fax/paper:
  Consumer Affairs Department
  Insurance Regulatory and Development Authority
  9th Floor, United India Towers,
  Hyderguda, Basheerbagh,
  Hyderabad – 500 029
  Telangana

In the unlikely event that the policyholder is not happy with the resolution provided by the company, they may approach the Insurance Ombudsman located in their region. Some relevant information:

• The office of the Insurance Ombudsman has been established by the Government for the redressal of any grievance in respect of life insurance policies.
• In case the insured/policyholder is not satisfied with the decision/resolution of the company, they may approach the Insurance Ombudsman of their state or an appropriate judicial/quasi-judicial authority having jurisdiction over the matter for redressal of your grievance.
• Details related to the Insurance Ombudsman have been provided in the policy documents.

The insured/policyholder may approach the Insurance Ombudsman if the grievance pertains to:

• Insurance claims that have been rejected or any dispute on the legal construction of the policy
• Delay in settlement of claims
• Dispute with regard to the premiums
• Non-receipt of the insurance documents

The complaint should be made in writing and be duly signed by the complainant or his/her legal heirs with full details of the complaint and the contact information of the complainant.

The address of the Insurance Ombudsman may be obtained online at www.irdaindia.org.in.

As per Provision 13(3) of the Redressal of Public Grievances Rules, 1998, the complaint to the Ombudsman can be made:

• Only if the grievance has been rejected by the grievance redressal machinery of the insurer
• Within a period of one year from the date of rejection of the insurer
• If it is not simultaneously under any litigation