Insurance Ombudsman/Insurance Ombudsman Scheme in India

The Insurance Ombudsman Scheme was created by Government for individual policyholders to have their complaints settled out of the courts in a cost-effective, efficient and impartial way. There are 12 Insurance Ombudsman in different locations and anyone can approach the one having jurisdiction over the location of the insurance company office that you have a complaint against.

Click the following link to view the address of Ombudsman in India (http://www.irda.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo234&mid=7.2 ).

Highlights of Institution of Insurance Ombudsman

  • 12 Ombudsman Centres, covering the country, established in Ahmedabad, Bhopal, Bhubaneswar, Chandigarh, Chennai, Delhi, Guwahati, Hyderabad, Kochi, Kolkata, Lucknow and Mumbai.
  • Centres became fully operational during the financial year 1999-2000.
  • Procedure is quick and free of cost.
  • Apart from regular hearings at the Centres, Insurance Ombudsmen hold outstation hearings within their territorial jurisdiction for the convenience of complainants.
  • With a current complaint disposal rate of 74.70% as on 31.03.2012, the institution has given a good account of itself as an alternate Grievance Redressal Machinery in Insurance Sector.

When you can approach the Ombudsman with a complaint:

  • If you have first approached your insurance company with the complaint and they have not resolved it or not resolved it to your satisfaction or not responded to it at all for 30 days
  • If your complaint pertains to any policy you have taken in your capacity as an individual and
  • If the value of the claim including expenses claimed is not above Rs 20 lakh

Complaint to the Ombudsman could 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.