Ashok had a problem with his Life Insurance as multiple policies were sold to him whereas he asked for one policy only. After along correspondence with 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 local insurance ombudsman. Within 60 days, Ombudsman called both parties and awarded order in favour of Ashok.
Ravi was having a medical insurance with a reputed Health Insurance company. Ravi was hospitalised but Insurer paid only 50% bills refusing to pay balance on account of room rent. Once again case of Ravi was settled at Ombudsman.
Whether you have life, health or General Insurance, you can approach local ombudsman for the resolution of your complaint. You do not need any lawyer or mediator to reach ombudsman. In 2000, Insurance sector was opened to Private Sector under regulations of IRDA. IRDA formed a body for grievance redressal. An Institution of Insurance Ombudsman was formed with basic objective of redressal of grievances of Policy Holders of all three i.e Life, Health and General Insurance. Ombudsman work under Insurance Council and have multiple centres covering almost all top cities in India. Each ombudsman office has a territorial jurisdiction.
Types of complaint represented to the Insurance 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 Ombudsman office directly or can send registered letter or mail. Complainant can not take help of any mediator.
- Firms can also approach ombudsman through an authorized representative.
How a complaint can be made?
- After receiving a denial letter from Insurer or after 30 days of sending a written complaint to insurer.
- Complaint can be made in writing.
- Complaint need to make within one year of denial from Insurer.
- If any proceedings are going on with Consumer Court than Ombudsman cannot be approached.
- Ombudsman do not charge any fees.
Insurance Ombudsman Awards
- Mediation – Insured and Insurer can seek mediation.
- After representation by both parties, Ombudsman award decision which is binding on Insurer however Insured can still approach consumer court or take other legal recourse. Insurer has to comply award within 15 days.
- Mostly Ombudsman has to award decision within 90 days.
Insurance Samadhan is a grievance redressal platform which guide aggrieved public with all platforms and help in preparing facts in technical language which can be easily understood by 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.
You can also
Visit our website: insurancesamadhan.com
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