Kathmandu. The law gives the right to not only file a complaint but also recover compensation along with interest if the insurer has not paid the claim even after completing all the due process and proof as per the terms and conditions of the policy.
Section 128 of the Insurance Act, 2079 empowers the insured party to file a complaint against the insurer, claim compensation with interest at the rate of ten percent until the period of receiving the claim late and to recover all the expenses incurred while seeking legal remedy.
Rule 90 of the Insurance Rules 2081 BS has the provision that the claim should be settled within 18 days of the claim being made by the person receiving the payment as per the terms and conditions of the policy. The insured party can immediately file a complaint with the Nepal Insurance Authority (NIA) if the claim payment has been delayed and more than 18 days has been delayed even after submitting all the documents asked for by the insurer. When they file a complaint, the insurer will have to pay the amount of interest for the period of delay in the event that they should not only be able to pay the claim amount but also the damages.
As per the provisions of the Insurance Regulations, while paying the death claim on behalf of the insured, the details of the claim, the death registration certificate of the insured, the report of the post-mortem regarding the cause of death of the insured person and the police report and the relationship certificate with the insured should be submitted. If you die during treatment, you have to submit all the documents related to treatment such as OPD, emergency, hospitalization, medical recommendation, laboratory report, X-ray report, bill and compensation related to the treatment.
Upon receipt of such application, the insurer has to examine the details of the documents submitted regarding the life insurance claim, if necessary, and within 15 days from the date of receipt of such documents, determine the liability and issue a notice in the name of the applicant to come to collect the claim payment. If the applicant agrees to the notice, the insurer should pay the claim within 3 days.
Sub-section (1) of Section 128 of the Act states that if the insurer fails to pay the insurance claim to the insured within the period specified in the policy, does not determine the liability or determines the liability to the insured, the concerned insured can complain to the Authority. Similarly, in case a complaint is received, the Authority should give 15 days time to the concerned insurer to submit the response after conducting necessary investigation
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(a) Settlement between the complainant and the insurer,
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(b) To order the payment of reasonable compensation to the insured for any loss caused by non-payment of the claim,
(c) To give an order to the concerned insurer to determine the liability again if it is not found that the liability determined by the insurer is not reasonable,
(d) If it appears that the insurer has to pay the claim, order shall be issued to the concerned insurer for the payment,
(e) To make other appropriate orders.
Clause (4) states that if a complaint is filed against any insurer due to non-payment of claim as per the policy, the concerned insurer shall also pay the amount equal to the actual cost of obtaining legal remedy at the rate of 10 percent from the date of receipt of the complaint.
Section (5) states that the insurer, insured or any other person who is not satisfied with the order issued by the Insurance Authority pursuant to Sub-section (3) may appeal to the concerned High Court within thirty-five days.
