Introduction
When your insurance company rejects your claim or you’re stuck in a never-ending loop of customer service calls, you might feel helpless. But the good news is that you have options to get your grievances resolved. Two key players can help you fight for your rights: the Insurance Ombudsman and IRDAI’s Bima Bharosa portal.
At Insurance Samadhan, we often get asked about the difference between these two mechanisms. While both exist to help you resolve insurance disputes, they work differently and serve distinct purposes.
What Are These Two Systems?
1. Bima Bharosa Portal: It is an online complaint platform by IRDAI (Insurance Regulatory and Development Authority of India). It lets you file a complaint against an insurer, track progress, and escalate if needed. It’s your second step after trying to resolve things with your insurance company.
2. Insurance Ombudsman: It is a government-appointed official who acts as a neutral authority to resolve insurance disputes for individual policyholders. It offers a more formal process and gives a legally binding decision to the insurer.
The Right Complaint Path
1. Start by filing a complaint directly with your insurance company. If you don’t get a reply in 15 days or you’re unhappy with their response, you can take it further.
2. Your next step is the Bima Bharosa Portal. You upload your complaint and documents, and the insurer is required to respond under IRDAI’s watch.
3. If the issue is still not resolved or you’re not satisfied, and your claim amount is Rs 50 lakhs or less, you can then approach the Insurance Ombudsman. You must do this within one year of receiving the final response (or no response) from your insurer.
Who Can Use These Systems?
The Bima Bharosa Portal is open to everyone, individuals, companies, agents, brokers, and intermediaries. There’s no limit on claim amount, and the whole process is online.
The Insurance Ombudsman is only for individual policyholders. You can approach the Ombudsman only if your claim is Rs 50 lakhs or less and only after trying to resolve the issue with your insurer first.
What Kind of Complaints Do They Handle?
Bima Bharosa handles a wide range of issues: delayed claims, rejections, mis-selling in insurance, agent misconduct, service problems, and regulatory violations. It also accepts complaints against insurance agents, brokers, and intermediaries.
The Insurance Ombudsman focuses on complaints like delay of claims or claim rejection, premium disputes, non-issuance of policies after payment, misrepresentation of policy terms, and poor customer service.
Which One Should You Use?
Use the Bima Bharosa Portal if:
1. You want to file online and track your complaint easily
2. You’re dealing with a company policy or group insurance
3. Your issue involves an insurance agent, broker, or intermediary
4. You’re dealing with a regulatory violation or mis-selling or issues related to claims
5. You will get response in 14 days
Use the Insurance Ombudsman if:
1. You’re an individual policyholder
2. Your claim is for Rs 50 lakhs or less
3. You want a binding legal decision the insurer must follow
4. You’ve already gone through Bima Bharosa or your insurer’s process
5. You’re dealing with a simple claim dispute
Can You Use Both?
Yes, but not at the same time. You can begin with Bima Bharosa for speed and convenience. If you’re not satisfied with the response or no action is taken, and your case meets the criteria, you can then approach the Ombudsman.
Once the Ombudsman accepts your case, you usually can’t pursue the same complaint in other forums like consumer courts or IRDAI again.
How Insurance Samadhan Helps
At Insurance Samadhan, we’ve helped thousands of policyholders resolve their insurance disputes through both these channels. We assist in:
1. Drafting clear, strong complaints
2. Organising right documents in a proper manner
3. Understanding which forum is best for your case
Our experience shows that most rejections happen not because of weak claims, but because people don’t present their case properly.
What You Should Prepare
Before filing a complaint, make sure you have:
1. A copy of your insurance policy
2. All emails or letters from your insurer
3. Claim forms, bills, or supporting documents
4. A written record of your complaint and insurer’s reply (or silence)
5. A clear timeline of events
The better prepared you are, the stronger your case becomes.
Final Words
If your insurer is being unfair or unresponsive, you have the right to take action. Start with the insurer, escalate through Bima Bharosa, and finally approach the Insurance Ombudsman if needed.
Both systems exist to protect policyholders like you. At Insurance Samadhan, we’re here to help you understand the process and fight for what’s rightfully yours.
Don’t let a claim rejection be the end of your story. Know your options and take the next step with confidence.
Click here to register your complaint with Insurance Samadhan
Visit our website: insurancesamadhan.com
Mail us at corporate@insurancesamadhan.com
