You Must Know How to Approach Insurance Ombudsman

How to Approach Insurance Ombudsman

Almost everyone faces the negative side of insurance companies when it comes to claim settlement, as insurers applies every possible reason to reject claim partially or fully. But still many are not aware of ombudsman offices and their role in winning the claim for the policy holders or deceased i.e. the legal heir. But do you know the process to approach insurance ombudsman? Here is the process and other important details:

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  1. Policy holders can complain to ombudsman for any insurance type – auto, accident, life, health, home etc.
  2. First step – contact insurance company: You can approach the ombudsman by first making the representation to the grievance redressal department of the insurance company. As per rule, acknowledgement should be sent to the policy holder within 3 days of receipt of the complaint. And the company has to resolve the dispute within 15 days.
  3. Second step – contact ombudsman: If response from the company is still not satisfactory, then escalating the issue to the ombudsman is the next step. Ombudsman will accept any written E-mail/complaint sent to the insurer even if there is no /wrongful response from the insurer. So consumer should have every thing documented while approaching the ombudsman so that queries will make task for ombudsman office easy and help in faster result.
  4. Filing complaint: It should be made via fax/E-mail/post along with the mandatory documents. For a safer side, if you have sent an E-mail then also send the complaint via post with all the necessary details mentioned clearly as ombudsman office receive lot of complaints every day.
  5. Where to approach: Make sure to file the complaint with the insurance ombudsman under whose jurisdiction the branch or office of the insurance company is located.
  6. Time limit to approach: Policy holder should contact ombudsman with a year after your claim gets rejected whether partly or fully. Check out when to approach ombudsman
  7. Who can approach: Policy holder/deceased should be present in person while approaching the ombudsman office. No insurance agent or lawyer should present the case in your absence.
  8. Fees: Ombudsman office never asks for any fees. So be careful if someone asks for the same.
  9. Dispute amount limit: Ombudsman handles complaints when the dispute amount is less than Rs. 20 lakhs.
  10. If policy holder has already started the proceedings before consumer forum or court, then he/she should not approach ombudsman.
  11. What if this also fails: Ombudsman tries every possible way to resolve consumer’s disputes. But still sometimes, if they fail to win case for you, then you should approach consumer court or forum for resolving their disputes.

You should also know why claims get rejected and precautions before buying policy

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