What is the Process to File a Case with Insurance Ombudsman in India?

The IRDAI or Insurance Regulatory and Development Authority of India have arranged a procedure for insurance companies to handle the complaints of customers. In case you have any questions or you desire to file a complaint or grievance, then the insurance company must be in the first place you wish to visit; however, if you are not fulfilled with the response, you can approach the Insurance Ombudsman. Scroll down to check more information regarding Insurance Ombudsman in India.

Insurance Ombudsman – Meaning

The Government of India announced the Insurance Ombudsman Scheme to aid the policyholders to attain their grievances addressed and resolved off the court effectively and in an impartial manner. Currently, there are seventeen Insurance Ombudsman Centres in India. The contact details of them can be retrieved from the official website of IRDAI. The grievance can be filed to the Insurance Ombudsman under whose authority on the branch of the Insurance Company or its office is situated or where the complainant lives.

The primary objective of the Ombudsman scheme is to resolve all the complaints experienced in the settlement of these claims.

When and Who can Approach the Insurance Ombudsman?

First, any person policyholder may approach Insurance Ombudsman for redressal for their complaint. Second, there are definite types of complaints for which a policyholder can approach the Insurance Ombudsman. Following are some complaints for which a policyholder can approach:

• Arguments pertaining to premiums paid or payable for life or general insurance policy;
• In the case of issuance of an insurance policy that is not in compliance with the submitted proposal form. It can be concerning life insurance, health insurance, or any other insurance products;
• In the case of any hold up in the claim settlement, beyond the time-limit, mentioned as per the regulations under the IRDAI Act, 1999^[1];
• Complaints concerning the services of policy by an insurance company, a mediator, or an agent;
• Any grievances concerning the infringement of provisions of the Insurance Act, 1938 or the regulations, guidelines, and notifications issued by the regulatory body;
• In the case of non-issuance of the insurance policy after receipt of premium by the insurance company. This can be related to health insurance, life insurance, or any other standard insurance products;
• In the case of any partial or complete rejection of claims by the general insurer or life insurer;
• Any disputes relating to the legal construction of insurance policies in so far as such dispute relates to claim.

Process to File a Complaint with Insurance Ombudsman in India

A complaint can be filed tremendously seamlessly and quickly. Following are the steps by step that should be followed:

1. In case one fails to get a suitable reply from the insurance company on their complaints or in case you haven’t received a reply on time that is within one month from the complaint, proceed to file a grievance or complaint with the Ombudsman;
2. Speak to the Insurance Ombudsman office that comes in the purview of your jurisdiction. For example, you live in Bangalore, and the office of an insurance company is placed in Mumbai, then you can approach Ombudsman in Bangalore centre for filing the complaint;
3.  The complaint may be file by sending a letter hardcopy to the Ombudsman or through fax or mail. But, in case you mail your complaints or grievances, you have to send the hard copy of the letter;
4. The letter should consist of all the vital details such as the policy number and details of the complaint. Enclose the important documents as demanded by the Ombudsman and post them to the centre. The documentation necessity may vary and depends on the type or nature of the complaint filed;
5. If you go to the Ombudsman centre, you can fill the Form P-II and P-III. If you have sent all the vital documents by post, the Ombudsman will interact with you asking to fill these forms;
6.  Once the complaint is submitted and all vital documents are also submitted, a date will be settled by the Ombudsman for hearing.

Settlement Procedure Followed by the Insurance Ombudsman

The Ombudsman plays an essential role as an intermediary between the insurance company and the policyholder. The Ombudsman depends upon the details to arrive at a fair recommendation and accept it as the final statement; the Ombudsman will copy the insurance company by sending an acceptance letter. It should be fulfilled within fifteen days.

However, if you are not satisfied with the recommendations, the Ombudsman shall pass an award within three months, which would be compulsory for the insurer. The insurance company is required to obey the award within thirty days.

Conclusion

An Insurance Ombudsman plays an essential role as an intermediary between the insurance company and the policyholder. Its function and responsibility are vital with respect to preserving a healthy relationship with the policyholder and the insurance company or entity. If you encounter any problem concerning insurance, you should first visit your insurance company and then the Ombudsman.

Read our article:IRDAI Notifies the Insurance Ombudsman (Amendment) Rules 2021