Article

Insurance Ombudsman
September 12 , 2012

Insurance Ombudsmen are vital to smooth servicing of insurance. They are like umpires for insurance who come into the picture when an insured person has a grievance. Ombudsmen are appointed by representatives of IRDA, LIC and GIC for a period of three years. There are 12 ombudsmen appointed for different jurisdictions in India. Details of ombudsmen are available at the website of irda and also tabulated in the ready reckoner listed in additional reading section below.

What the ombudsman can do for you

If the insurer's response on a dispute you have raised with them is not satisfactory, you can take it to the ombudsman under whose jurisdiction the insurer's office falls. Ombudsmen can be approached for issues relating to

1. Claim rejection

2. Dispute on premiums

3. Dispute on policy wording relating to claims

4. Delay in claim settlement

5. Non-issuance of relevant documents by the insurer after accepting premiums

He/she has the power to consider complaints and settle it by recommending what he judges is fair for the case. The ombudsman must pass award of claim within 3 months of filing complaint. The awards are binding upon the insurer. Ombudsman's recommendation is to be sent to both the insurer and complainant within a month of arriving at settlement by the ombudsman.

Lodging complaint with ombudsman

Either the policy holder or the legal heirs of the insured can file a complaint with the ombudsman. Complaint must be in writing. A complaint can be lodged only after it has first been taken up with the insurer itself and either they have not responded in a month or have rejected the complaint or the complainant is not satisfied with the reply. If the insurer has rejected complaint, it must be lodged with the ombudsman within a year. However while applying it must not be pending before any court or consumer forum.  

Last resort

Ombudsmen have done commendable work in handling grievances of policy holders so far. Confidence in them is steadily increasing. But in case you are not satisfied with the award an ombudsman has given you what more can you do? You could try Consumer Forums and for last resort lodge compliant at a Court of Law.

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