Document text
BY COURIER / REGISTERED POST A.D. AND BY E-MAIL — PLEASE ACKNOWLEDGE RECEIPT
Date: [DD/MM/YYYY]
To:
The Head of Claims / Complaint Officer
[NAME OF INSURANCE COMPANY / TAKAFUL OPERATOR]
[HEAD OFFICE OR BRANCH ADDRESS]
[COMPLAINT / GRIEVANCE E-MAIL ADDRESS]
From:
[FULL NAME OF POLICYHOLDER / CLAIMANT]
CNIC No. [XXXXX-XXXXXXX-X]
[POSTAL ADDRESS]
[MOBILE] · [E-MAIL]
[IF CLAIMING AS NOMINEE OR LEGAL HEIR: RELATIONSHIP TO THE DECEASED POLICYHOLDER]
Subject: Delay in settlement of claim No. [CLAIM NUMBER] under Policy No. [POLICY NUMBER] — demand for payment with liquidated damages under section 118 of the Insurance Ordinance, 2000, and notice of intention to file a complaint with the Federal Insurance Ombudsman under section 129(2)
Dear Sir/Madam,
1. I am the [POLICYHOLDER / NOMINEE / LEGAL HEIR] under the following policy:
Policy No. Type of policy Insured / life assured Event (death, accident, hospitalisation, theft, damage, maturity) Date of event
[POLICY NUMBER] [LIFE / HEALTH / MOTOR / PROPERTY / TAKAFUL] [NAME / VEHICLE / PROPERTY] [EVENT] [DD/MM/YYYY]
2. I intimated the claim to you on [DD/MM/YYYY] and was given claim No. [CLAIM NUMBER]. I submitted all the documents you required, the last of them on [DD/MM/YYYY], as acknowledged by [YOUR LETTER / E-MAIL / RECEIPT No. ___ DATED ___]. [IF A SURVEYOR WAS APPOINTED: Your surveyor [NAME] inspected the [VEHICLE / PROPERTY] on [DD/MM/YYYY].]
3. The amount payable under the policy is Rs. [CLAIM AMOUNT] (Rupees [AMOUNT IN WORDS] only) [OR: as per the surveyor's assessment dated ___]. More than ninety days have passed since the payment became due / since I complied with all your requirements, but the claim has not been paid. [IF ANY REPLY WAS RECEIVED: Your letter dated ___ asked for ___, which I supplied on ___. / Your letter dated ___ declined the claim on the ground that ___, which is not correct because ___.]
4. Under section 118 of the Insurance Ordinance, 2000, it is an implied term of every contract of insurance that, where the claimant has complied with all the requirements, including the filing of complete papers, and the insurer fails to pay within ninety days from the date on which the payment becomes due or the date on which the claimant complies with the requirements, whichever is later, the insurer must pay liquidated damages for the period of delay, calculated at monthly rests at a rate five percent higher than the prevailing base rate.
5. I therefore call upon you to:
a) pay the claim amount of Rs. [CLAIM AMOUNT];
b) pay liquidated damages under section 118 from [DATE: 90 DAYS AFTER THE LATER OF THE DUE DATE OR THE DATE OF COMPLETE PAPERS] until the date of actual payment;
c) if you require anything further, tell me in writing what exactly is missing and why; and if you decline the claim, give me the reasons in writing together with copies of the surveyor's or investigator's report and any other document you rely on.
6. Please treat this letter as my written intimation under section 129(2) of the Insurance Ordinance, 2000, of my intention to file a complaint with the Federal Insurance Ombudsman if you fail to respond, or give an unsatisfactory reply, within one month of receiving this letter. I also reserve my right to approach the Insurance Tribunal or any other competent forum.
Yours faithfully,
______________________________
[FULL NAME]
CNIC No. [XXXXX-XXXXXXX-X]
[MOBILE] · [E-MAIL]
Enclosures (copies):
1. Policy schedule / certificate No. [POLICY NUMBER]
2. Claim intimation and claim form dated [DD/MM/YYYY]
3. Receipts / acknowledgements of all documents submitted
4. [FIR / MEDICAL RECORDS / DEATH CERTIFICATE / SURVEY REPORT / REPAIR ESTIMATE]
5. Correspondence with the company
6. CNIC (and succession certificate or nomination proof, if claiming as heir)
NOTES BEFORE SENDING — delete this part
Ninety days: the insurer must pay within 90 days from the date the payment became due or the date you completed all requirements (including complete papers), whichever is later. After that, liquidated damages accrue at base rate + 5% a year, calculated at monthly rests (section 118). "Base rate" is the State Bank's six-month Treasury Bill repurchase rate as defined in section 2.
Keep proof of the date you submitted the last document. That date usually starts the 90 days. If the company keeps asking for "more documents", reply in writing each time and keep copies.
One month, then three months: this letter is also your written intimation under section 129(2). If the company does not reply, or replies unsatisfactorily, within one month, you can file a complaint with the Federal Insurance Ombudsman at any time within the next three months. The Ombudsman may condone a delay for good reason.
The complaint to the Ombudsman must be in writing, on solemn affirmation or oath, with full particulars of the transaction and your name and address (section 129(1)). The Ombudsman should dispose of it within 60 days (section 9(5) of the Federal Ombudsmen Institutional Reforms Act, 2013).
The Ombudsman cannot take up a matter that is already pending before a court or tribunal (section 129(4)).
Send the letter by a method that gives you a delivery date (courier, registered post A.D., e-mail with read receipt). To be safe, count the one month from the date the company received your letter.
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