Complaint Response
Every regulator and policyholder complaint answered on time, with a reply drafted from the claim file.
Why it matters
Complaints arrive from state departments, Bima Bharosa, the ombudsman and customers, each with its own deadline; staff rebuild the claim story by hand and replies go out late.
How the solution handles it
Five agents read the complaint, set its clock by source (state rule, IRDAI or FCA), rebuild what happened from the claim file, check handling against rules and promises made, and draft a cited reply. A complaints officer reviews and signs.
How a complaint moves
Five specialist agents read the complaint, set its clock, review the file and draft the reply; a complaints officer reviews and signs.
What it reads, and what it hands back.
What goes in
- Department of insurance inquiries
- Bima Bharosa and ombudsman cases
- Customer emails and letters
- Claim file and notes
What comes out
- Signed response letter
- Complaint clock and status
- Handling findings
- Root-cause log
Who uses it
The difference, in numbers.
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
IRDAI: 14 days
Sources: IRDAI grievance rules (14 days) · NAIC Model 902 (21 days to answer a department; varies by state) · FCA DISP 1.6 (8 weeks) · “Target” = design goal, measured in the live solution · agents = the live solution’s configuration
5 specialist agents. One person decides.
More in this division.
Every first notice of loss read, scored and routed to the right adjuster within the hour.
Coverage LettersEvery coverage question answered from the policy wording, with a cited letter drafted for counsel.
Reserve ReviewEvery open claim’s reserve tested against its file each quarter, with gaps explained before anyone asks.
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