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• Best option for the consumer is to obtain Cashless facility i.e. the Insurance company pays the bills directly to the hospital. But the hospital must be part of their preferred network (PPN), which list should be available on the insurance company website.

• If you wish to take treatment in a hospital, which is not on the PPN cashless list, then make sure you intimate the Insurance company/ TPA within 24 hours of admission in any hospital.

• In case of a pre-planned surgery, it is better to inform the Insurance company/ TPA much earlier.

• As per IRDA’s guidelines to the Insurance companies, *the consumer cannot be forced to sign the discharge or Settlement Intimation voucher*. Signing the discharge voucher does not mean that the Insurer’s liability is over.


Disputes resolution, especially Claims processing

For claims-related complaints, consumers can write to the Grievance cell of the Insurance company. As per IRDA guidelines, grievances must be acknowledged by the Insurance company in 3 working days and it must be *resolved in 15 working days*. If there is no response to the letter, you can file a Right to Information (RTI) application with the Grievance Officer.
The *IRDA Call Centre (toll-free at 155255*) also offers an alternative channel for policyholders, serving from 8 AM to 8 PM, Monday to Saturday in Hindi, English and various Indian languages.

You can also write to *[email protected]* or online or through post at:
Consumer Affairs Department
Insurance Regulatory and Development Authority (IRDA)
3rd floor, Parishram Bhavan,
Basheer Bagh, Hyderabad

For still unresolved disputes of *less than Rs 20 lakhs* pertaining to claims settlement or regarding premiums paid/ payable and non-issue of insurance documents, the *Insurance Ombudsman* can be approached. The written complaint with the relevant claim papers can be send by the customer himself (*no lawyer is required*), within 1 year of dispute. After registering with the Ombudsman office, attach this application document.
Contact details of Insurance Ombudsmen in India

*Contact Details*
Jurisdiction
MUMBAI
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai – 400 054.
Tel.:- 022-26106928/360/889
Fax:- 022-26106052
Email:- *[email protected]* or
[email protected]

States of Maharashtra and Goa.
AHMEDABAD
Office of the Insurance Ombudsman,
2nd floor, Ambica House,
Near C.U. Shah College,
5, Navyug Colony, Ashram Road,
Ahmedabad – 380 014
Tel.:- 079-27546150/139
Fax:- 079-27546142
Email:- [email protected]

State of Gujarat and Union Territories of Dadra & Nagar Haveli and Daman and Diu.
BHOPAL
Office of the Insurance Ombudsman,
Janak Vihar Complex,
2nd Floor, 6, Malviya Nagar,
Opp.Airtel,
Bhopal – 462 011.
Tel.:- 0755-2769200/201/202
Fax:- 0755-2769203
Email:- [email protected]

States of Madhya Pradesh and Chattisgarh.
BHUBANESHWAR
Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar – 751 009.
Tel.:- 0674-2535220/3798/1607
Fax:- 0674-2531607
Email:- [email protected]
State of Orissa.

CHANDIGARH
Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd
Floor,
Batra Building, Sector 17 – D,
Chandigarh – 160 017.
Tel.:- 0172-2706196/5861/6468
Fax:- 0172-2708274
Email:- [email protected]

States of Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir and Union territory of Chandigarh.
CHENNAI
Office of the Insurance Ombudsman,
Fatima Akhtar Court,
4th Floor, 453 (old 312), Anna Salai,
Teynampet,
CHENNAI – 600 018.
Tel.:- 044-24333678/664/668
Fax:- 044-24333664
Email:- [email protected]

State of Tamil Nadu and Union Territories – Pondicherry Town and Karaikal (which are part of Union Territory of Pondicherry).
DELHI
Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi – 110 002.
Tel.:- 011-23239611/7539/7532
Fax:- 011-23230858
Email:- [email protected]

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• Best option for the consumer is to obtain Cashless facility i.e. the Insurance company pays the bills directly to the hospital. But the hospital must be part of their preferred network (PPN), which list should be available on the insurance company website.

• If you wish to take treatment in a hospital, which is not on the PPN cashless list, then make sure you intimate the Insurance company/ TPA within 24 hours of admission in any hospital.

• In case of a pre-planned surgery, it is better to inform the Insurance company/ TPA much earlier.

• As per IRDA’s guidelines to the Insurance companies, *the consumer cannot be forced to sign the discharge or Settlement Intimation voucher*. Signing the discharge voucher does not mean that the Insurer’s liability is over.


Disputes resolution, especially Claims processing

For claims-related complaints, consumers can write to the Grievance cell of the Insurance company. As per IRDA guidelines, grievances must be acknowledged by the Insurance company in 3 working days and it must be *resolved in 15 working days*. If there is no response to the letter, you can file a Right to Information (RTI) application with the Grievance Officer.
The *IRDA Call Centre (toll-free at 155255*) also offers an alternative channel for policyholders, serving from 8 AM to 8 PM, Monday to Saturday in Hindi, English and various Indian languages.

You can also write to *[email protected]* or online or through post at:
Consumer Affairs Department
Insurance Regulatory and Development Authority (IRDA)
3rd floor, Parishram Bhavan,
Basheer Bagh, Hyderabad

For still unresolved disputes of *less than Rs 20 lakhs* pertaining to claims settlement or regarding premiums paid/ payable and non-issue of insurance documents, the *Insurance Ombudsman* can be approached. The written complaint with the relevant claim papers can be send by the customer himself (*no lawyer is required*), within 1 year of dispute. After registering with the Ombudsman office, attach this application document.
Contact details of Insurance Ombudsmen in India

*Contact Details*
Jurisdiction
MUMBAI
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai – 400 054.
Tel.:- 022-26106928/360/889
Fax:- 022-26106052
Email:- *[email protected]* or
[email protected]

States of Maharashtra and Goa.
AHMEDABAD
Office of the Insurance Ombudsman,
2nd floor, Ambica House,
Near C.U. Shah College,
5, Navyug Colony, Ashram Road,
Ahmedabad – 380 014
Tel.:- 079-27546150/139
Fax:- 079-27546142
Email:- [email protected]

State of Gujarat and Union Territories of Dadra & Nagar Haveli and Daman and Diu.
BHOPAL
Office of the Insurance Ombudsman,
Janak Vihar Complex,
2nd Floor, 6, Malviya Nagar,
Opp.Airtel,
Bhopal – 462 011.
Tel.:- 0755-2769200/201/202
Fax:- 0755-2769203
Email:- [email protected]

States of Madhya Pradesh and Chattisgarh.
BHUBANESHWAR
Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar – 751 009.
Tel.:- 0674-2535220/3798/1607
Fax:- 0674-2531607
Email:- [email protected]
State of Orissa.

CHANDIGARH
Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd
Floor,
Batra Building, Sector 17 – D,
Chandigarh – 160 017.
Tel.:- 0172-2706196/5861/6468
Fax:- 0172-2708274
Email:- [email protected]

States of Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir and Union territory of Chandigarh.
CHENNAI
Office of the Insurance Ombudsman,
Fatima Akhtar Court,
4th Floor, 453 (old 312), Anna Salai,
Teynampet,
CHENNAI – 600 018.
Tel.:- 044-24333678/664/668
Fax:- 044-24333664
Email:- [email protected]

State of Tamil Nadu and Union Territories – Pondicherry Town and Karaikal (which are part of Union Territory of Pondicherry).
DELHI
Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi – 110 002.
Tel.:- 011-23239611/7539/7532
Fax:- 011-23230858
Email:- [email protected]

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