Section 128: Complaint Relating to Payment of Claim

1) In case the insurer fails to pay an insurance claim within the period mentioned in the insurance policy, does not determine the liability, or does not determine the liability, causing detriment (loss) to the insured, the concerned insured may file a complaint with the Authority.

2) If a complaint is made pursuant to sub-section (1), the Authority shall provide a time of fifteen days for the concerned insurer to submit clarification after making the necessary investigation upon the complaint.

3) If the clarification pursuant to Sub-section (2) is received, receiving the evidence pertaining to it and if the clarification is not received from the insurer within the period prescribed to submit the clarification, the Authority may perform as follows:

(a) To make a compromise between the complainant and the insurer,

(b) To order to compensate reasonably if the insured suffered a loss due to not making payment of a claim,

(c) To order the concerned insurer to re-determine the liability if the pre-determined liability seems to be inappropriate,

(d) If it seems that the payment of claims  is to be made by the insurer to order the concerned insurer to make the payment,

(e) To give other appropriate orders.

4) If any complaint was made against any insurer due to not making payment as per the insurance policy and it is decided that the claim is to be paid, if so, the concerned insurer shall have to make payment of interest at the rate of ten percent from the date of filing complaint and amount equivalent to the actual expenses incurred for receiving legal remedies in addition to the insurance amount to the complainant.

5) Any insurer, insured, or any other person who is not satisfied with the order made by the Authority pursuant to sub-section (3) may appeal in the concerned High Court within thirty-five days.

6) Other provisions relating to actions upon the complaint under this section shall be as prescribed.