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CUSTOMER SERVICE -REGULATORY VIEW

. . . Underdeveloped Markets. Emerging Markets. Mature Markets. Motor insurance (3rd party liability). property insurance for large gov't projects. Marine and othertrade related transport insurance . Commercial property insurance. Motor insurance(comprehensive) . Liability in

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CUSTOMER SERVICE -REGULATORY VIEW

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    1. CUSTOMER SERVICE -REGULATORY VIEW By PC James Executive Director, IRDA

    3. CHALLENGING ENVIRONMENT

    5. FUNDAMENTALS OF AN IDEAL REGULATORY ENVIRONMENT PROTECTION OF THE CONSUMER PROMOTION OF THE INDUSTRY COMPETITIVE NEUTRALITY TRANSPARENCY COST EFFECTIVENESS ACCOUNTABILITY FLEXIBILITY

    6. PROTECTION ESTABLISH A REGULATORY FRAMEWORK TO PROVIDE ADEQUATE PROTECTION TO CONSUMERS PREVENT /ENFORCE SUCH REGULATIONS INSTIL PUBLIC CONFIDENCE

    7. 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

    8. COMPETITIVE NEUTRALITY * Level playing field for all participants * Minimal entry and exit barriers * No undue restrictions on institutions or products * Well – defined rules of game

    9. SOURCES OF REGULATIONS * Laws / Statutes - Government * Formal Regulations - Regulations Non-formal Regulations - Guidelines Self-regulation - Industry Internal Regulation - Corporate Governance

    10. LAW MAKES GENERAL FRAMEWORK FOR THE INDUSTRY EG. INSURANCE ACT 1938 IRDA ACT 1999 REGULATOR Issues specific rules & regulations Responsibility for enforcement

    11. JUDICIARY * Decide on suits * Give interpretations * Decide on the legality of an insurance practice

    12. 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

    13. 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

    14. SELLING METHODS LICENSING OF AGENTS / INTERMEDIARIES AGENTS CORPORATE AGENTS BACASSURANCE BROKERS SURVEYORS TPAS ADVERTISING

    15. 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

    16. 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.

    17. GRIEVANCE ISSUE PROCESSES SETTLING INDIVIDUAL GRIEVANCES ANALYSIS OF GRIEVANCES CATEGORISING GRIEVANCES DELAY STRUCTURAL/SERVICE ISSUES POLICY/ CONTRACT ISSUES

    18. REMOVING ROOT CAUSES ANALYSING ROOT CAUSES STUDY OF RULINGS, JUDGEMENTS EMPOWERED LEVELS TO TAKE CORRECTIVE ACTION REVIEW RESULTS CHANGE OF PRACTICES, SYSTEMS, PRODUCTS

    19. IRDA GRIEVANCE CELL

    20. IRDA GRIEVANCE CELL

    21. IRDA GRIEVANCE CELL

    22. IRDA’S CONCERNS PROHIBITED SALES PRACTICES AND UNETHICAL INTERMEDIATION MISLEADING ADVERTISEMENTS FAILURE TO PROVIDE PROPER DISCLOSURES INSENSITIVITY TO CONSUMER WELFARE DELAYS

    23. THE WAY FORWARD TIMELINESS. DECREASE PROCESS DELAYS NEED FOR CLARITY & QUALITY IN COMMUNICATION CREATE PROCEDURES FOR QUICK DECISION MAKING CONVEY WRITTEN DECISIONS & IF NEGATIVE WITH REASONS RECORD REASONS IN FILE INFORM AVAILABILITY OF EXTERNAL REMEDIES IF NOT RESOLVED INTERNALLY. USE PROCEDURES THAT INCREASE CONSUMER ACCESS

    24. THANK YOU

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