What is Insurance Ombudsman – Everything You Need to Know

What is the basic purpose of a term life insurance policy? Of course, to provide monetary security to a family in the event of sudden demise of  the head of the family or the policyholder during the tenure of the policy. People buy term plans with a faith that their families will not suffer if they had to leave this world suddenly without performing their responsibilities. The insured show complete trust in the insurance company for taking care of the finances of his/her family and expect the insurer to abide by the claim request in case of his/her sudden demise. The policyholder also wants to ensure that the insurer would address the claim related issues of their family by making it a hassle free process.

Thus, to ensure the same the government of India has formed the Insurance Ombudsman body for insurance policyholders and their families. It enables beneficiaries of policyholders to settle complaints by means of out of court settlement.  Normally, the first step is to approach the grievance redressal  cell to address a consumer complaint. If it is not resolved in that cell, then you can approach the  insurance Ombudsman to get an impartial and effective conflict settlement.

Insurance Ombudsman Meaning

Ombudsman Insurance was established as a government body in November 1998 with the primary aim to  fasten up as well as to regulate the process of grievances settlement of policyholders. The body aims at settling all issues that the policyholders or their nominees may experience in the settlement of claims. Hence the basic aim of the body is to offer unbiased and effective settlement of complaints. There are over 17 Insurance Ombudsman in India in locations mentioned below:

• Mumbai
• Delhi
• Bangalore
• Pune
• Ahmedabad
• Bhopal
• Chandigarh
• Bhubaneswar
• Chennai
• Guwahati
• Jaipur
• Hyderabad
• Kolkata
• Kochi
• Lucknow
• Noida
• Patna

What is the time limit for approaching an insurance ombudsman?

Below are the cases in which you can  approach the Ombudsman:

• If you register a complaint with your insurer and the complaint gets rejected. Or if your insurer has not responded to your complaint in 30 days or has not solved the issue as per your satisfaction
• If your complaint is related to your life term insurance plan
• If the worth of your life insurance complaint is beyond INR 30 lakhs

In the above situations, you need to raise a complaint in writing as per the format of the Insurance Ombudsman. There are many ways of raising the complaint. You can either visit the Ombudsman office  or send a letter by post, by email or by fax. In case you raise the complaint via email, you must submit a hard copy as well.

In case of insurance rejection by the insurer you must file the complaint within a year of the rejection. Further, while filing the complaint just remember that the case should not be pending with the consumer forum or in the court.

Who is Eligible to File a Complaint with the Insurance Ombudsman?

Anyone can make a complaint with the Insurance Ombudsman in India if they have any grievance in connection to their insurance plan. They can raise it on their own or through their legal nominees/heir etc.

Concerns that can be raised with the Insurance Ombudsman in India

Below are the concerns that can be raised with the Insurance Ombudsman in India:

• In case there is a delay in insurance claim settlement beyond the time mentioned by the Insurance and Regulatory Development Authority of India. This is similar for any insurance plan – life, term, health, motor and so on
• If the insurer completely or partially rejects a claim of your term plan
• If there is any disagreement between the insurer and insured regarding premium payment
• If there is any discrepancy in the policy documents of your insurance plan
• If your insurer issues a policy that is different from the one opted by you
• If the insurer doesn’t issue insurance plan even after making the premium payment
• If you face any other violation of the terms that are mentioned in the Insurance Act, 1938

How to File a Complaint with the Insurance Ombudsman?

Follow the steps below to file a complaint with the Insurance Ombudsman:

Visit the office of Insurance Ombudsman in your area to file your complaint. Irrespective of the geographical area where your office is located, you can raise an Ombudsman complaint anywhere in India.

Follow the Ombudsman complaint format to file your grievance along with sending a hard copy to the Ombudsman office. Email and fax can also be used to send your complaint.

The complaint you raise must have all the details of your policy such as information related to premiums that are paid and if any are pending, about the details of the complaint, the steps that your insurer took and so on. You may also be required to share a few documents with the Ombudsman office.

As soon as the complaint is registered, you may have to fill in two forms; P-II and P-III, especially if you have raised your complaint by post. Once these formalities are over, a date of hearing will be issued by the office of Ombudsman.

What settlement process is being followed by the Insurance Ombudsman?

Basically, the insurance Ombudsman serves the role of a mediator between the insured or nominee of the insured and the insurance company. Thus, it helps the parties in question to reach an amicable solution in a justified way. Once the parties agree with the process of settlement of the Ombudsman, the insurer is expected to oblige with the settlement terms within 15 days.

But in case the settlement does not work, the Ombudsman will pass a verdict in three months time which the insurer must abide by within 30 days.