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Insurance Concepts and IRDA [Insurance Regulatory and Development Authority]

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Right to Information (RTI) Act, 2005

The Right to Information Act, 2005 (http://www.persmin.nic.in) was enacted by the Government of India with effect from October 13, 2005. Under this Act, the Right to Information confers or grants access to the citizens of India regarding access to information under control of public authorities for promoting transparency and accountability in governmental organizations. However, under Sections 8 and 9 of Right to Information Act, certain categories of data or confidential information are exempted from disclosure to the general public. Under this Act, a clause has been incorporated for appointment of a Chief Public Information Officer to specifically deal with requests for information under the control of government including public agencies.

Obligation of IRDA under RTI Act

The Insurance Regulatory and Development Authority (IRDA) is a public authority as defined in the Right to Information Act, 2005. As such, IRDA is obliged to disclose information to Indian nationals in accordance with the provisions of the Act.

The right to information includes access to data or information under the control of any public authority. As a result, the public have been granted privileges and rights incorporating the right to inspect any document, record, work, making notes, collecting extracts, notes or certified copies of documents/records, certified samples of substances or materials and/or obtaining data or information which is also stored in electronic format.

IRDA Website

The IRDA maintains an active website (URL: http://www.irdaindia.org). The website is updated regularly. All the information released by IRDA is simultaneously made available on the website. The information published in public domain incorporates the following features:

1. Acts/Regulations

2. Information pertaining to Insurers/Reinsurers, Appointed Actuaries and Agents Training Institutes

3. Information related to Insurance Brokers, Corporate Agents, Surveyors and Third Party Adminstrators (TPA)

4. Information relating to Insurance Councils and Insurance Ombudsman

5. Annual Reports & IRDA Journals

6. Press Releases

Complaints against Insurance Companies or Third Party Administrators (TPA)

Under the provisions of this Act, IRDA has provided an exclusive channel for lodging complaints against any deficiency in products or services rendered by Insurance Companies or the Third Party Administrators (TPA). On account of poor quality, deficiency or shortfall in services being rendered by an Insurance Company or TPA including its offices or branches and incase of persistent requests made by the concerned policyholder to address his/her complaints/grievances remains unresolved, such individuals have the liberty to approach the Nodal Officer of the concerned Insurance Company or TPA. If the individual remains dissatisfiedwith the response of the concerned Insurance Company or TPA, the individual can file a complaint by approaching the Insurance Ombudsman. Under IRDA Act, the Insurance Ombudsman is an independent office that provides speedy and cost-effective resolution pertaining to grievances of the policyholder. For more details on Insurance Ombudsman Scheme and their respective contact details, the policyholder is requested to visit http://www.irdaindia.org/ins_ombusman.htm.

Complaints from Policyholders

Policyholders who have complaints against their insurers or TPAs are required to first approach the Grievance/Customer Complaints Cell of the concerned Insurance Company. If they do not receive a response from their insurer/TPA within a reasonable time-frame or are dissatisfied with the response of the company or are dissatisfied with the quality of services being offered, such policyholders may approach the Grievance Cell of the IRDA for resolving their grievances. Such details are available on IRDA website http://irdaho/irdaweb/grievancescell.htm

Making an Application under the Right to Information Act, 2005

Indian citizens can make the request pertaining to disclosure of data or information in writing, clearly specifying the information being sought under the Right to Information (RTI) Act, 2005 and the purpose of seeking it. The application for request should contain the contact details (name, postal address, telephone number, fax number, email id) of the concerned applicants so that they can be contacted for clarifications or for further information, incase, if such need arises. As per the provisions of RTI Act, such information can be furnished only to citizens of India but cannot be disclosed to others. If such data or information is leaked to individuals who are not Indian citizens, then it results in breach of violation followed with suitable legal action.

Sending an application

As per the Right to Information (Regulation of Fee and Cost) Rules, 2005 prescribed by the Government of India, a request for obtaining information under Section 6(1) of RIA needs to be accompanied by an application fee of Rs.10/- by way of cash against proper receipt or by DD or bankers’ cheque.

It is possible to dispatch an individual’s request by post accompanied by the application fee of Rs.10/- payable by demand draft or bankers’ cheque drawn in favour of IRDA (Insurance Regulatory and Development Authority). Another alternative is that the fee can be paid in cash along with the application by the concerned individual. Applications can also be made via fax or email. IRDA takes up the processing the application of an individual for consideration, only after the application fee has been received, under the provisions of the Act.
All such requests can be addressed to any of the concerned Central Public Information Officers (CPIOs).

Duration taken by IRDA take to provide information under RTI Act

Within 30 days of receiving the receipt of the application requesting for information along with the prescribed fees, IRDA will communicate to the requestor (or the concerned individual) whether it can or cannot provide the information.

Guidelines to be followed for deriving the information under RTI Act

As per the Right to Information (Regulation of Fee and Cost) Rules, 2005, the public authority shall charge as follows:

Rs.2/- for each page (in A-4 or A-3 size paper) created or copied;

Actual charge or cost price of a copy in larger size paper;

Actual cost or price for samples or models being sought

For inspection of records, no fees for the first hour and thereafter a fee of Rs.5/- for each 15 minutes (or fraction thereof).

Under Section 7(5) of the Right to Information (RTI) Act, 2005, for dissemination or providing relevant data or information the concerned public authority shall charge as follows:

Rs. 50/- per diskette or floppy 

For information provided in printed form based on the price fixed for such publication or Rs. 2/- per page of photocopy for extracts from the publication.

If IRDA has the desired data or information and is in a position to provide it to an individual it will, within 30 days of receiving the application pertaining to the request along with appropriate fees. Under Section 7(1) of Right to Information (RTI) Act, it will communicate to the concerned individual the cost of providing the data or information as prescribed. Incase, if the data is confidential, secretive or sensitive in nature, IRDA has the right to withhold such information under the provisions of RTI Act.

Refusal of Disclosure of Information by IRDA


Under Sections 8 and 9 of the Right to Information (RTI) Act, 2005, certain categories of data or information are totally prohibited or exempted from disclosures to the public. Such data or information includes:

a) Disclosure of Data or Information that would prejudicially affect the sovereignty and integrity of India, the security, strategic, scientific or economic interests of the State, relations with foreign countries or lead to incitement of an offence.

b) Data or information which has been expressly forbidden to be published by any court of law or tribunal or the disclosure of such information that may constitute contempt of court.

c) The disclosure of information that would cause a breach of privilege of Parliament or the State Legislature.

d) Information that includes commercial confidence, trade secrets or intellectual property, the disclosure of such data or information that would harm the competitive position of a third party, unless and until the competent authority is satisfied that larger public interest warrants the disclosure of such information.

d) Information available to a person in his fiduciary relationship, unless the competent authority is satisfied that the larger public interest warrants the disclosure of such information.

e) Data or information received from foreign Governments that is confidential and its disclosure would endanger the life or physical safety of any individual or identify the source of information or assistance given in confidence for law enforcement or security purposes concerning India or its states or its subjects.

f) Information that would impede the process of investigation or apprehension or prosecution of actual offenders.

g) Cabinet papers including records of deliberations of the Council of Ministers, Secretaries and other gazette officers.

h) Information that relates to personal information and the disclosure of such data bears no relationship of any public activity or interest, or disclosure of any such data or information that may result in unwarranted invasion of the privacy of the individual.

Right to Appeal

Under the provisions of Right to Information (RTI) Act, 2005 an individual has been conferred the right to appeal incase if the concerned person remains disdissatisfiedwith the information provided by IRDA or the decision not to disclose or disseminate the data or information as requested. The appeal can be addressed to:

Insurance Regulatory and Development Authority (IRDA)
3rd Floor, Parisrama Bhavan,
Basheer Bagh,
Hyderabad 500 04
Ph: (040) 66820965 (D) 6682 0964 / 66789768
Fax: (040) 6682 3334

Under the provisions of this Act, incase, if an individual is dissatisfied with the decision of the appellate authority within IRDA, he/she can appeal against this verdict to the Central Information Commissioner appointed in terms of Chapter III of the Right to Information Act, 2005.

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I wish to lodge a complaint against SBI Insurance Co. Ltd. with you. How I can proceed in this matter. I am from Delhi. Sushma Malhotra.
smlibra Sunday, April 13, 2014
IF I AM EMERGENCY ADMITE SERIAS CONDITION IN HOSPITAL.THAT TIME I AM NOT CHECK THE HOSPIRAL REGISTRATION and NOT COUNT NUMBER OF BEDS. and HOSPITAL HAS LESS THAN 10 BED REGISTRATION. CAN INSURANCE COPMANY REIMBURSMENT OF CLAIM ?
deven_dra1 Sunday, August 18, 2013
Dear Sir, I have a insurance policy Kotak Mahindra, and paid only one lakh and the other cheque when I sent out it came back undeliverable. I am an NRI. Now when I am writing to Kotak Mahindra regarding the reimbursement of my money they are not replying. Is there a email id or place where I can lodge a complain
pinto Wednesday, December 19, 2012
Myself and my wife aged abot 70 Years [and in good Health so far] have Health Insurance Policy (presently of Rs. 2.25 each) for the last Ten Years with No Claim so far. It is due for renewal shortly. We propose to change Scheme to Family Medicare Policy Flotter subsequently. Will we get benefit of old Policy in the new scheme? De-facto, it is continuance of Health Policy with change of scheme only Jagdish
Jagdish2501 Sunday, September 16, 2012
It is very good. After all, the Chairman of a regulatory body like the IRDA should have domain knowledge on Insurance. For far too long the country has suffered with retired IAS officers getting mansabs or sinecures as Chairmen of these bodies
knowall Wednesday, July 04, 2012
sir, i m runing a trust ...can i take a policy in the name of one of my director
ajeett Wednesday, October 19, 2011
sir, i had invested 45000/- in 1994 in senior citizen plan of u t i,and was given an insurance cover for expances on treatment,i was given no claim bonus and the total amount swelled to over 7 lacs.Last year i got injury in my eye.It was operated several times. and my bill for operation and medicines swelled to 1.80 lacs which included my hospital fee medicines. my transport from Sikar to DELHI as no train connection was there so taxi charges,and some of my previous bills of treatment which were of small amounts.I was handed over a cheque of nearly 67000/- my repeated enquiries as to how so much deduction were made,did not get a response. in fact this whole money is for treatment of me and my spouse.I am 72 yrs i asked that if I dont survive long enough to utilize this amount where this money goes. No reply to this. also can U please solve this.I was in touch with 01123741283, neerja Patra manager at uti Delhi my policy no is 109540310000230,,109540300000230,DR V.K.Khanna M.D FICA USA LLb Sikar liondrvkkhanna@yahoo.co.in
liondrvkkhanna Wednesday, September 14, 2011
Who frames the rules, conduct and terms for insurance policies: Finance ministry or IRDA or insurance companies themselves?? Most of the govt insurance companies discontinue the cover under personal accident and health insurance after insured reaches particular age. Who has approved such policies? Pl. give copy of circular in this regard issued by or approved by Dept. of Financial Services, Insurance Division. 7. Most of the general insurance companies offer cashless card for health cover. But they or their TPA approves this card and sanction limits to hospital against request for cashless approval. a] Whether as per government guidelines prior approval is necessary ?? Pl. give relevant copy of circular. b) Can insurer / TPA ask for copies of policy/ policies inspite of insured carrying valid cashless card and getting admitted in approved panel hospital Even if he possesses cashless card or original copy of latest valid policy document? c) Can insurer ask for 6 to 10 years of policy documents? Is insured suppose to keep old policy documents? If yes then for how many years. d) With in what time frame in the approvals for cashless admission/ treatment / hospitalization must be given by insurers as per the guidelines of govt/ IRDA? Give copy of same. e) If the cashless approval does not come and patient has been admitted in emergency and is not in his home town and is unable to get funds then what is a remedy for such cases?? f) Have u fixed some penalty / cancellation of licence for erring insurers / TPA’s and what is a procedure? g) Whether settlement of claim depends on latest policy terms or is based on old policies too??? In accounts we carry forward all debits and credits to latest balance sheet. And the latest balance sheet reflects the true and latest status/ balances of anyone. Same way the latest policy should contain all limitations/ exclusions / what company will pay, what is the percentage of expenses allowed per day on room etc. But insurers / TPA’s ask form insured copies of old policy documents?? Pl. give copy of relevant documents / govt guidelines/ IRDA guidelines on this issue.
tholiya Sunday, August 28, 2011
sanguineinsurance @gmail.com writes Grievances can be sent to CALL CENTER : TOLL FREE NO:155255 Contact information: Complaints against Non-life insurance companies: Private Insurers: Shri K.Srinivas, Asst. Director, Insurance Regulatory and Development Authority Consumer Affairs Department United India Tower, 9th floor, 3-5-817/818, Basheerbagh, Hyderabad – 500 029. e-mail ids:complaints@irda.gov.in Public Sector Insurers: Mr.R.Srinivasan, Officer on Special Duty Insurance Regulatory and Development Authority Consumer Affairs Department United India Tower, 9th floor, 3-5-817/818, Basheerbagh, Hyderabad – 500 029. e-mail ids: complaints@irda.gov.in Complaints against Life Insurance Companies: Mr. T Venkateswara Rao, Deputy Director Insurance Regulatory and Development Authority Consumer Affairs Department United India Tower, 9th floor, 3-5-817/818, Basheerbagh, Hyderabad – 500 029. e-mail id: complaints@irda.gov.in Register The IGMS can be used by policyholders but they must first register themselves on the site www.igms.irda.gov.in/ Information Apart from providing personal details and contact information, the complainant must select an identification number such as PAN, passport number, voter ID, etc.
SANGUINEINSURANCE Tuesday, August 02, 2011
Hello, Sir, I bought a policy from TATA AIG in october 2010,policy no. "u031246134" for Rs50000.00.The advisor told me that i will recieve the policy documents within 1 month meanwhile i called the agent several times for my bond each time she gave me false assurance that they were on the way ,I kept waited for 45days but hadn't recieved the policy so finally I asked the agent to cancel my policy due to bad services rendered to me and asked her refund the complete amount as it was in "FREELOOK" period they canecelled my policy and sent out a cheque of Rs 46350.34.I lodged acomplaint in their branch for incomplete refund they assured me that remaining amount of Rs 3633.60 will refunded later . My ordeal started from there I made several complaints for the remaining amount but they are making fun of mee and keep harrassing me, all this caused a lot of mental agony and harrassment by this insurance company because they are not folowing the "IRDA RULE THAT A CUSTOMER CAN CANCEL HIS OR HER POLICY WITHIN 15DAYS IF HE OR SHE IS NOT SATISFIED WITH POLICY TERMS". I made severals complaint to concerned authorities to address my grivences but noone is paying any heeds to my pain ,so I request you to take some strict action against this errant company to get my remianing hard earned money Rs 3633.60 along with the judicial monetary compensation for the inconvenience caused to me from the last 7months .Plz I request you as I saved that money for my daughter's future and due their callous attitude i can not buy a new policy from a reputed insurance company I am "UNEMPLOYED " FROM LAST 4 MNTHS . "PLZ. HELP ME "
jatin78 Friday, May 27, 2011
sir i read all post and i noticed that your unemployed.sir i have a way which is best and better way to change your life .and sir there is no investment needed,in this way you can secure your and your family life both also for more details contact:tlcnet@in.com
well_wisher Thursday, September 22, 2011

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