Insurance Ombudsman: Complaint Procedure, When & How to Approach

Many people face troubling behaviour of insurance companies be it life/auto and others. And their grievances are mostly about claim amount not paid, policy documents not received etc. If your queries are unanswered or unsatisfactory reply is received even after repetitive calls or e-mails to the customer care or physically visiting insurance offices multiple times, then contacting insurance ombudsman is the final solution. Their main job is to address the insurance holder’s grievances which will give you the result within 90 days of filing the complaint.

What is ombudsman?

It was implemented by the Indian government on 11th November 1998 with a main objective of settling insurance related disputes, protect consumer’s rights, and build a sense of trust between customers and insurance companies. Across India, ombudsman has 12 offices divided into different zones and it’s not necessary that one office is limited to one state only. Complaint needs to be sent to the jurisdiction of the ombudsman office where insurance office falls.

And here’s what you need to do to act against the insuring company: “Send written/fax/E-mail the complaint to the insurance ombudsman office”

When to approach ombudsman?

Following are the conditions for which you should approach the ombudsman:

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  • Policy is not received even after the successful payment
  • Claim is rejected with irrelevant reasons
  • Claim amount not received even after the acceptance of the claim
  • Dispute regarding premium paid and payable
  • Dispute regarding terms and conditions of the policy
  • Delay in claim processing

But there are certain terms and conditions to be met before approaching the ombudsman. So before you approach make sure:

  • You have already filed complaint to the insurance company
  • Complaint is filed but reply is not received within 30 days
  • Response is not satisfactory
  • Complaint is not filed elsewhere such as consumer forums, court and others

What happens when you file complaint at ombudsman?

Ombudsman is authorized to settle dispute of insurance claims for upto Rs. 20 Lacs. They give final decision in 3 months time and insurance companies are bound to follow their verdict.

What to do when you’re not satisfied with ombudsman’s reply?

It’s not necessary that ombudsman will give 100% positive solution. And in such cases, you will have to approach consumer forum or court for getting your complaint resolved.

Contact details of the grievance redressal department of IRDA:

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