Scribd Logo
Upload

Welcome to Scribd!

  • 26 views

    Grievance Management Policy and Procedure

    Uploaded by

    Krutika Rathore

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Grievance Management Policy and Procedure

    Uploaded by

    Krutika Rathore
    26 views4 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    26 views4 pages

    Grievance Management Policy and Procedure

    Uploaded by

    Krutika Rathore

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 4

    Grievance Management Policy & Procedure

    Vidal Health Insurance TPA Pvt Ltd


    1. Introduction
    The purpose of Grievance management policy is to set forth the policies and procedures to be followed
    in receiving, handling and responding to any grievance against Vidal Health Insurance TPA in respect of
    the services offered.

    2. Definition
    “Grievances or complaint” includes any communication that expresses dissatisfaction, in respect of any
    delay or deficiency of service and in the nature of seeking a remedial action but do not include the
    following—
    i. complaints that are incomplete or not specific in nature;
    ii. communications in the nature of offering suggestions;
    iii. communications seeking guidance or explanation;

    3. Objective
    The following are broad objectives for handling the customer grievances:

     To provide fair and equal treatment to all customers of Vidal health Insurance TPA without bias
    always.
     To ensure that all issues raised by customers are dealt with courtesy and resolved in stipulated
    timelines.
     To develop an adequate and timely organizational framework to promptly address and resolve
    customer Grievances fairly and equitably.
     To provide enhanced level of Customer satisfaction.
     To provide easy accessibility to the Vidal Customers for an immediate Grievance redressal.
     To put in place a monitoring mechanism to oversee the functioning of the Grievance Handling
    Policy.

    4. How to raise a grievance


    Customers can raise grievances through the following modes:

     Phone Call: Call at 24x7 Helpline No. given in the Vidal ID Card
     Email: write to help@vidalhealthtpa.com given in the Vidal ID Card
     Letter: Raise the grievance by writing to any of the VHITPA branch
     Website: Login to www.vidalhealthtpa.com and register the Grievance
     Visit Branches of VHITPA: Walk-in to any VHITPA branch to register complaints.

    5. Registration of grievances & Acknowledgements


    (i) Grievances received through phone call are recorded in the system and will be answered
    immediately. The grievances that need escalation/need additional details will be escalated within
    the Vidal system.

    (ii) Grievances received through written communication:

    a. The grievances can be received through given email ID, acknowledgement will trigger
    immediately assigning the Ticket No., providing the timeline for revert and Escalation point.
    b. The grievances can be received through letter will be reverted within 7 working days

    6. Redressal of Grievance and TAT


     The complaint letter / email should contain the VHITPA ID number/ Employee No. with
    Corporate Name/ policy No. and Insured name, Complainant’s name, address and contact
    details, copies of supporting documents, wherever applicable.
     All the complaints shall be registered in VINGS application of VHITPA.
     The complaint shall be addressed as early as possible and within three working days of the
    receipt of the complaint. Resolution shall be communicated to the complainant.
     All complaints shall be escalated to the next higher level of authority within the organization for
    cases which are pending for resolution for more than 7 working days from the date of sending
    Acknowledgement. Cases which are escalated will be dealt with and monitored by Senior
    Grievance Executive.
     Manager – grievance would monitor the resolution of complaints received by VHITPA and
    Periodically put up the same for review by the Senior Management.
     The Grievance Redressal Policy is accessible to all and it ensures that information is readily
    available on the modalities of making and resolving complaints.
     Complaint details will be kept confidential and shall be shared with regulatory authorities only if
    in accordance with the relevant laws.
     Sharing of information otherwise will only in circumstances where the Insurance Ombudsman or
    IRDAI Requested is necessary for resolving the complaint.
     All complaints shall be monitored and marked as closed only after resolution of the customer
    grievance.

    7. Resolution of grievance
    The complainant shall be intimated on resolution of grievance/complaint on call if received through
    phone, and through same ticket No., if received through email. If it is received through letter, then the
    intimation of resolution letter shall contain the Date of receipt of complaint/grievance, Name,
    Designation of Grievance officer signing the communication.

    8. Escalation of grievance
    Any customer whose grievance has not been resolved within 7 working days from the date of receipt of
    the grievance, or who is not satisfied with the resolution provided can escalate by writing to email id
    grievance.escalation@vidalhealthtpa.com.

    Level Designation Contact Emai-id


    Level 1 Grievance Cell Care@vidalhealthtpa.com, help@vidalhealthtpa.com
    Level 2 Grievance Manager grievance.escalation@vidalhealthtpa.com
    Level 3 Chief Administrative Officer cao@vidalhealthtpa.com
    Level 4 Chief Executive Officer ceo@vidalhealthtpa.com

    9. Maintenance of records and reporting


     Manager Grievance shall preserve records pertaining to grievance / complaint received
    resolution and closure of the grievance. VINGS Application shall be updated with the
    details after sending intimation of resolution to the customer.
     Manager Grievance shall submit required reports to management and to Insurers as and
    when requested

    10. Closure of grievance


    A grievance shall be considered as closed in any of the following instances, namely:
    a) When the customer has acceded to the reply given over phone.
    b) Where the complainant has indicated in writing, its acceptance of the response;
    c) Where no further communications is received on the same issue.

    You might also like