(Protection of Policyholders’

Interests) Regulations, 2017

Submitted by
Sunny Dwivedi 202225
Richa Kantode 202240
Pankaj Kumar 202246
Anjali Seth 202273
Mayur Shelke 202278
 To ensure that interests of insurance policyholders’
are protected.

To ensure that insurers, distribution channels and

other regulated entities fulfil their obligations
Objectives towards policyholders and have in place standard
procedures and best practices in sale and service of
insurance policies.

To ensure policyholder-centric governance by

insurers with emphasis on grievance redressal.
 Steps to be taken for enhancing Insurance Awareness so as to
educate prospects and policyholders about insurance products,
benefits and their rights and responsibilities.

Service parameters including turnaround times for various services

rendered.

Scope Procedure for expeditious resolution of complaints

Steps to be taken to prevent mis-selling and unfair business

practices at point of sale and service.

Steps to be taken to ensure that the prospects are fully informed and
made aware of the benefits of the product being sold.
  Proposal form is compulsory except in case of a marine insurance cover
 In case of marine insurance cover or other insurance covers where a proposal
form is not used, the insurer shall record the information obtained orally or in
writing or electronically, and confirm it within a period of 15 days
 the prospect is to be guided by the provisions of Section 45 of the Act.
 Wherever the benefit of nomination is available to the proposer, the insurer or
Proposal form the distribution channel shall draw the attention of the proposer to it and
encourage the proposer to avail the facility and inform him of the provisions of
section 39 of the Act.
 decision on the proposal shall be communicated in writing to the proposer
within a reasonable period but not exceeding 15 days from the date of receipt
of proposals
 Where a proposal deposit is refundable to a prospect under any circumstances,
the same shall be refunded within 15 days from the date of underwriting
decision on the proposal.
  The unique identification number (UIN)
 The scope of benefits;
 The extent of insurance cover;
 Warranties, exclusions/exceptions and conditions of the insurance
A prospectus of cover along with explanations.
 A description of the contingency or contingencies to be covered
any insurance by insurance

product shall The allowable riders or add-on covers on the insurance products


 The premium pertaining to health related or critical illness riders

clearly state 
shall not exceed 100% of premium under the basic product,
The premiums under all other life insurance riders put together
shall not exceed 30% of premiums under the basic product
 Purpose

Necessity of Insurance awareness

Insurance
Awareness Insurance Awareness Committee

Awareness about Grievance and

Dispute Resolution
  Electronic marketing including social media
 Establishing initial contact with certain target group and
educating them about protection and insurance related products
 Delivering Insurance Education through agents, intermediaries,
Action Plans for trained employees, educational Institutions.
Creating awareness about consumer protection and grievances
implementation

redressal machinery
 Customer portal to be used to educate the customers.
 Insurance Awareness advertisements to be issued from time to
time on various aspects affecting customers in English, Hindi and
all Regional languages.
 Pan India campaign on TV as well as radio channels.
 Prevention of mis-selling & unfair business
practices
 Purpose
Details in the prospectus
Action Plan for Training to different Highlighting the Important
shall be simple and easy to
 Vision implementation distribution channel exclusions of the policy
understand

Sample calling at periodic

interval to ascertain whether Details of the policy Weekly review of Periodic feedback from
the policy details are wording to be available on Grievances by the CEO customers after claim
correctly explained during the website under settlement
the sale

Highlighting the provisions

Any other steps as suggested
of Sec.41 of Insurance Act,
by the management from
1938 (Prohibition of
time to time
Rebates) in the prospectus
 Sr.
No. Service Level (Claims) TAT
1 Appointment of Surveyor after claim intimation 72 hrs
Information to Insured / Claimant of essential documents and other

Service 2
requirements that the claimant should submit in support of the
claim 7 days
3 Start of survey by the Surveyor after his appointment 48 hrs

parameters 4 Submission of Interim Report by the Surveyor after his first visit 15 days

including 5
Submission of Final Report to the Insurer after appointment of
Surveyor 30 days
Submission of Final Report in commercial or large risk to the

turnaround 6
7
Insurer after appointment of Surveyor
Settlement of claim by the insurer after receipt of final report
90 days
30 days

times 8
Request by Insurer to furnish an additional survey report on certain
specific issues after submission of final report
Offer a settlement of claim to claimant/insured after receipt of final
15 days

9 survey report or additional survey report 30 days

Rejection of claim to claimant/insured after receipt of final survey
10 report or additional survey report 30 days
 Sr No.
Description of service

Free look cancellation/surrender/Withdrawal/Request for refund of proposal

deposit/Refund of outstanding proposal deposit subject to receipt of all documents 15 days
1

Service 2
Maturity claim/Survival Benefit /Annuity/Pension processing subject to receipt of all
documents On or before due date

parameters
3 Raising claim requirements after lodging the claim 15 days

4 Death claim settlement without investigation requirement 30 days

including
5 Death claim settlement/Repudiation with investigation report 120 days

6 Issuance of policy document after acceptance of the proposal 5 days

turnaround 7 Registration of nomination/ Assignment/ Re-assignment and return of policy document

Effecting revival/ alteration/issue of duplicate policy on receipt of all requirements

3 days

times
8 2 days

9 Loan settlement after receipt of all requirements 3 days

Effecting change of address/ transfer In-Out and other enquiries under the policies
10 Same day

11 Acknowledge a grievance 3 days

12 Resolve a grievance 15 days

  Grievance Redressal Officer
 Every insurer shall have a system including IT systems
and a procedure for receiving, registering and disposing
Grievance of grievances in each of its offices

Redressal  Grievance Management System

 Publicizing Grievance Redressal Procedure
Procedure  System to receive and deal with all kinds of calls
including voice/e-mail, relating to grievances
 A complaint shall be considered as disposed of and closed
when
 a. The insurer has acceded to the request of the
complainant fully
Closure of  b. Where the complainant has indicated in writing,
acceptance of the response of the insurer.
complaint/grievance
 c. Where the complainant has not responded to the
insurer within 8 weeks of the insurer’s written response
 Insurance Ombudsman
Thank you