Insurance Ombudsman: How you can Register Complaint to Ombudsman

Insurance Ombudsman: How you can Register Complaint to Ombudsman

Ashok had a problem with his Life Insurance as multiple policies were sold to him whereas he asked for one policy only. After a long correspondence with the Insurer, they refused to comply and sent a refusal letter. Within 30 days, Ashok prepared a small note in Hindi and represented the case to the local ombudsman. Within 60 days, the Ombudsman called both parties and awarded orders in favour of Ashok.

Ravi was having medical insurance with a reputed Health Insurance company. Ravi was hospitalised but the Insurer paid only 50% bills refusing to pay balance on account of room rent. Once again the case of Ravi was settled at the Ombudsman.
Whether you have life, health or General Insurance, you can approach the local ombudsman for the resolution of your complaint. You do not need any lawyer or mediator to reach the ombudsman. In 2000, the Insurance sector was opened to the Private Sector under IRDA regulations of IRDA. IRDA formed a body for grievance redressal. An Institution of Insurance Ombudsman was formed with the basic objective of redressal of grievances of Policy Holders of all three i.e Life, Health and General Insurance. Ombudsman works under the Insurance Council and has multiple centres covering almost all top cities in India. Each ombudsman office has a territorial jurisdiction.
Types of complaint accepted by the Insurance Ombudsman
Following complaints can be represented at the ombudsman:
Claim Repudiation
Delay in claim settlement
Partial claim settlement
Any dispute related to Policy Terms and Conditions
Complaint of fraud and mis-selling
Policy Servicing Issues
Complaint against intermediaries
Who can make a Complaint?
Any insured person or legal heirs can make a complaint in writing to the ombudsman within whose jurisdiction office of insurer is located
Complainant need to visit the Ombudsman office directly or can send registered letters or mail. Complaint can not take help of any mediator.
Firms can also approach the ombudsman through an authorised representative.
How a complaint can be made?
After receiving a denial letter from the Insurer or after 30 days of sending a written complaint to the insurer.
Complaints can be made in writing.
Complaint needs to be made within one year of denial from Insurer.
If any proceedings are going on with the Consumer Court then the Ombudsman cannot be approached.
The Ombudsman does not charge any fees.
Insurance Ombudsman Awards
Mediation – Insured and Insurer can seek mediation.
After representation by both parties, the Ombudsman award decision which is binding on the Insurer however Insured can still approach consumer court or take other legal recourse. Insurer has to comply with the award within 15 days.
Mostly the Ombudsman has to award a decision within 90 days.
Insurance Samadhan is a grievance redressal platform which guides the public with all platforms and helps in preparing facts in technical language which can be easily understood by the Ombudsman.

At InsuranceSamadhan.com, we have helped resolve over 12,600 customer grievance cases in the past related to Life Insurance, Health Insurance, General Insurance and other financial products.
To reach us at InsuranceSamadhan.com –
Call us at – 844 844 0626
Mail us at – corporate@insurancesamadhan.com
Register your insurance complaint here