When you feel that your insurer hasn’t addressed your concerns fairly, the Insurance Ombudsman is your go-to solution.
In this blog, you will explore everything you need to know
- What is Insurance Ombudsman
- Who can file a complaint
- The Framework
- How to make a complaint
- The Process
What is an Insurance Ombudsman?
The Insurance Ombudsman scheme was created by the Government of India for individual policyholders to have their complaints settled out of the court system in a cost-effective, efficient, and impartial way.
There are at present 17 Insurance Ombudsman in different locations and any person who has a grievance against an insurer, may himself or through his legal heirs, nominee, or assignee, make a complaint in writing to the Insurance ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential address or place of residence of the complainant is located.
Office locations of the insurance ombudsman
- Mumbai
- Pune
- Delhi
- Bangalore
- Ahmedabad
- Bhopal
- Chandigarh
- Kolkata
- Bhubaneswar
- Guwahati
- Chennai
- Hyderabad
- Jaipur
- Noida
- Kochi
- Lucknow
- Patna
Key Features of the Insurance Ombudsman
Below, we have mentioned the key features of the Insurance Ombudsman:
Easily accessible
The Ombudsman is available to all policyholders, irrespective of their claim amount or location. Complaints can also be filed online, through post, or in person at designated offices.
Transparent and Fair
The Insurance Ombudsman is informal and avoids the complexities of legal proceedings. Both sides can present their case, ensuring a fair and transparent process.
Quick resolution
The Insurance Ombudsman mandates a time-bound resolution process, with most cases being disposed of within 3 months. This ensures quick resolution for policyholders who often face financial difficulty due to insurance issues.
Cost-effective
Filing a complaint with the Ombudsman is free, making it a viable option for policyholders who need more financial resources to seek legal recourse.
Following Reasons to file a complaint with the Insurance Ombudsman
- Delay in settling claims beyond the time specified under the IRDAI Act, 1999.
- Disputes over the premium paid or payable under the insurance policy.
- Partial or complete rejection of claims by life, general, or health insurers.
- Misrepresentation of policy terms and conditions in the policy document or contract.
- Disagreements over the interpretation of policy terms related to a claim.
- Grievances about policy servicing involving insurers, agents, or intermediaries.
- Issuance of an insurance policy (life, general, or health) that doesn’t match the submitted proposal form.
- Non-issuance of an insurance policy after the premium has been paid.
- Any other issue arising from violations of the Insurance Act, 1938, or IRDAI regulations, circulars, guidelines, or policy terms linked to the points above.
Key Functions of the Insurance Ombudsman
- Addressing Grievances: Resolves complaints about delays, policy servicing, or claim rejections.
- Promoting Fairness: Ensures insurance companies adhere to fair practices.
- Providing Accessibility: Offers an easy and free alternative to lengthy legal processes.
How to file a complaint with the Insurance Ombudsman?
- You can reach out to the office of the Insurance Ombudsman. For instance, if you are residing in Delhi, you can contact the Insurance Ombudsman Delhi office to file a complaint. The geographical location of your insurance company does not matter. The company could be based anywhere in India.
- File a complaint in the insurance ombudsman format and send a hard copy to the insurance ombudsman. You can also send your complaint by email or fax. Once your complaint is registered, the Insurance Ombudsman shares with you Form P-II and P-III. If you file your complaint via post, the Insurance Ombudsman will ask you to fill out these forms.
- Key details to share include policy information, premiums paid or pending, a detailed description of your complaint, and the steps taken by the insurance company so far. You’ll also need to send relevant documents to the Insurance Ombudsman office in your area.
- After these formalities, the Ombudsman will issue a date for hearing.
Grievance Settlement Process of Insurance Ombudsman
The Ombudsman serves as a mediator between you and the insurance company, helping both parties reach a fair resolution. Based on the facts of the case, the Ombudsman provides a justified recommendation. If you accept the settlement, the insurance company must comply with the terms within 15 days.
If a settlement isn’t reached, the Ombudsman will issue a binding award within three months. The insurer will then have 30 days to implement the award
Bottom Line
The Insurance Ombudsman is a vital institution for policyholders facing grievances. If you’re stuck in a dispute with your insurer, don’t hesitate to reach out to this body for justice. Remember, every policyholder deserves fair treatment and resolution.
For more information, visit the official website of the Insurance Ombudsman or contact the nearest Ombudsman office.
FAQs
Who can file a complaint with the Insurance Ombudsman?
Any individual policyholder or their legal heirs can file a complaint if the issue pertains to a personal line of insurance (e.g., life, health, motor policies) and the claim amount does not exceed ₹30 lakh.
How long does it take to resolve a complaint?
Typically, the Ombudsman resolves complaints within three months of receiving all required information.
What if I’m not satisfied with the Ombudsman’s decision?
If you are not satisfied with the Ombudsman’s decision, you can pursue legal action or approach a consumer court for further resolution.
Can corporate or group policies be taken to the Ombudsman?
No, the Insurance Ombudsman handles complaints related to individual policyholders only, not group or corporate policies.
Can I file a complaint online?
Yes, you can submit a complaint online through the official Ombudsman portal or by email to the relevant Ombudsman office.
