Understanding the Role of the Insurance Ombudsman
The Insurance Ombudsman is one of the most important grievance redressal mechanisms created by the Insurance Regulatory and Development Authority of India (IRDAI).
It was established to help policyholders get speedy and fair resolution of their complaints without having to go through lengthy court battles.
Whether it’s a claim rejection, policy mis-selling, delay in settlement, or non-receipt of policy documents, the Ombudsman offers a free and impartial forum for customers to present their cases.
This is a system to trust and appreciate — one that has helped thousands of policyholders receive justice over the years.
Steps Involved in Raising a Complaint with the Ombudsman
If your complaint remains unresolved even after approaching your insurance company, here’s the process to reach the Ombudsman:
- Start with the insurer:
First, write to your insurer’s grievance redressal cell. The insurer has 30 days to respond. - If unresolved, approach the Ombudsman:
File your complaint online through the official Bima Bharosa portal or the Council for Insurance Ombudsmen website. - Submit your documents:
Upload relevant claim documents, correspondence, and any rejection letters received from the insurer. - Ombudsman review & hearing:
The Ombudsman examines the case, often calling for a hearing (virtual or in-person). Both parties — the policyholder and insurer — are heard. - Award (decision):
Based on the evidence, the Ombudsman issues an award — a decision that is binding on the insurer.
Where the Process Slows Down
While the intent of the Ombudsman system is commendable, ground realities show variations in efficiency across regions.
- In some cities, hearings take several months to be scheduled.
- Even after submission of all required documents online, complaints are occasionally marked as “closed”, leading to confusion and distress.
- The lack of acknowledgement or status tracking updates further frustrates policyholders already struggling through emotional and financial hardship.
At Insurance Samadhan, we regularly see cases where a policyholder’s health insurance claim for chronic illnesses like cancer remains unresolved for months — when in reality, speed means everything.
A delayed claim is a denied relief for someone already battling for their life.
The Challenges That Need Attention
- Digital platform inconsistencies:
The online portals sometimes fail to record document submissions properly, resulting in wrongful case closures. - Regional disparity:
Some Ombudsman offices are efficient and responsive, while others struggle with backlog and limited staff. - Complex process for elderly or rural consumers:
Many policyholders find it difficult to navigate online forms and document uploads. - Limited awareness:
A majority of consumers are still unaware of the Ombudsman system or their right to approach it.
How the Process Can Be Strengthened
- Better tracking and transparency:
Introduce real-time complaint tracking and clear status communication via SMS or email. - Digital verification for submissions:
Automatically validate uploaded documents to prevent wrongful case closures. - Dedicated time limits for chronic care claims:
Health insurance claims related to life-threatening or long-term illnesses should be prioritized. - Stronger collaboration between insurers, Ombudsman, and digital redressal platforms like Insurance Samadhan, which already help policyholders with claim preparation and documentation.
Why Insurance Samadhan Supports the Ombudsman Framework
At Insurance Samadhan, we truly appreciate the spirit behind the Ombudsman system — a mechanism designed to make justice accessible and free.
We have seen countless cases where the Ombudsman’s intervention has restored faith in the insurance system.
However, we also believe that speed and sensitivity must go hand-in-hand with fairness.
A system that is meant to deliver justice must also ensure it is timely, especially in cases involving medical emergencies or financial distress.
Conclusion: Justice Must Be Swift to Be Just
The Insurance Ombudsman remains a pillar of consumer protection in India’s insurance ecosystem.
But to truly fulfill its purpose, the process must become simpler, faster, and more transparent.
Until then, Insurance Samadhan continues to stand by policyholders — helping them prepare complete, well-documented cases and guiding them through the journey of grievance redressal. Because for us, every claim matters, and every day counts.
Click here to register your complaint with Insurance Samadhan
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Mail us at corporate@insurancesamadhan.com