The Insurance Ombudsman scheme was
created by Government of India for individual policyholders to have their
complaints settled out of the courts system in a cost-effective, efficient and
impartial way.
There are 12 Insurance Ombudsman in different locations and you can approach
the one having jurisdiction over the location of the insurance company office
that you have a complaint against.
You can approach the Ombudsman with complaint if:
- You have first approached your insurance company with
the complaint and
- They have not resolved it
- Not resolved it to your satisfaction or
- Not responded to it at all for 30 days
- Your complaint pertains to any policy you have taken in
your capacity as an individual and
- The value of the claim including expenses claimed is
not above Rs 20 lakh
Your complaint to the Ombudsman can
be about:
- Any partial or total repudiation of claims by an
insurer
- Any dispute about premium paid or payable in terms of
the policy
- Any dispute on the legal construction of the policies
as far as it relates to claims
- Delay in settlement of claims
- Non-issue of any insurance document to you after you
pay your premium
The settlement process
Recommendation:
The Ombudsman will act as counsellor
and mediator and
- Arrive at a fair recommendation based on the facts of
the dispute
- If you accept this as a full and final settlement, the
Ombudsman will
- Inform the company which should comply with the terms
in 15 days
Award:
- If a settlement by recommendation does not work, the
Ombudsman will:
- Pass an award within 3 months of receiving the
complaint and which will be
- A speaking award with the detailed reasoning
- Binding on the insurance company but
- Not binding on the policyholder
- The Ombudsman can also award an ex-gratia payment
Once the Award is passed
- You have to accept the award in writing and the
insurance company has to be informed of it within 30 days and
- The Insurance company has to comply with the award in
15 days after that.
