Customer Service, Ethics and Grievance Redressal
Domain 9 tests fair treatment of customers, ethical selling and the escalation path when a complaint is not resolved. Questions often present a conduct scenario and ask for the correct response.
Core rules
- Fair treatment requires suitable advice, clear disclosure of premium, exclusions, waiting periods and risks, and no mis-selling.
- Rebating - sharing commission or offering an inducement to win business - is prohibited. Confidential customer data must not be misused.
- Customers should receive policy documents, renewal notices and claim information promptly. Grievances first go to the insurer’s grievance-redressal officer.
- If unresolved within the prescribed period, or if the reply is unsatisfactory, the customer may approach the Insurance Ombudsman under the Insurance Ombudsman Rules, 2017. IRDAI’s Bima Bharosa portal is a grievance channel.
- Records of complaints and advice should be maintained; staff must avoid conflicts of interest.
Worked example
An agent sells a market-linked policy to a retiree as a “fixed deposit with assured high returns” without explaining market risk and charges. The customer later complains. Correct handling: the insurer must examine the sales record, explain the product honestly, correct any demonstrable mis-selling and route the grievance through its redressal process; if unresolved, the customer can go to the Ombudsman. Reasoning: suitability and disclosure were breached; the remedy is redressal, not merely a verbal assurance.
Traps that cost marks
- Treating a complaint as a claim.
- Offering rebating to retain a customer.
- Saying the Ombudsman is the first stop before the insurer.
- Ignoring documentation of advice and disclosure.