The Insurance Ombudsman is a scheme of the government to address those complaints of the policyholders for effective and efficient settlement of the problems out of the courtroom and in an impartial manner.

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Insurance Ombudsman In India

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• Government scheme to address
complaints of the policyholders for
effective and efficient settlement of the
problems out of the courtroom.
• There are 17 Insurance Ombudsmans in
different regions of the country.
Overview Of Insurance Ombudsman In India

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 Complaints not been resolved, unsatisfactory solution or lack of response for
complaint within 30 days of the submission of the complaint to the insurance
company.
 Complaint related to any of the policy purchased.
 The claim value including the amount claimed as expenses not more
than 20 lacs.
When To Approach Insurance Ombudsman

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 Insurance company in total or partial denial of the claims made by the insured
person or his family members
 Any issue related to premium payable or paid for the insurance policy
 Claims for legal issues related to the policy
 Unsettled claims within specified time frame by the insurance company
 Denial of insurance documents after first premium is paid to the insurance
company.
Insurance Ombudsman Can Be Approached For Following Disputes

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Recommendation
Assists both the parties to reach an impartial and fair decision and
recommendation after verifying the facts of the complaint.
The insurance company is required to act upon the decision within 15
days if the policyholder accepts the decision as the final one.
Award
Deliverance of award within 3 months of complaint which can be a speaking
award with detailed facts and reasoning on non acceptance of recommendation by
the policyholder.
On receival of the award, the policyholder needs to inform the insurance company
& the company needs to follow the same. The policyholder needs to accept the
award in writing.
Steps To Approach Insurance Ombudsman

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Time Limit
• Within one year of the complete or partial claim rejection by the insurance
company.
Where To
approach
• Check for the Ombudsman’s jurisdiction of the insurance company placed
according to the region or location.
Dispute
Amount
Limit
• The amount of claim or the dispute must not exceed maximum limit of 20
lacs.
Procedure Related To Approaching Insurance Ombudsman

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Fees
• No fees charged from the policyholders.
Who Can
Approach
• The policyholder or the family member of the deceased policyholder.
Lawyers or agents not allowed to file a complaint on behalf of policyholder.
Place
• File the complaint via E-mail, fax or post along with mandatory documents
attested and attached.
Procedure Related To Approaching Insurance Ombudsman

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Results
• Solves every case with impartial decisions imparting fair
judgment. Provides policyholder right to approach the consumer
forum or consumer court for further investigation and judgment
Cannot
Approach
Ombudsman
• In case of complaint been filed in the consumer court and forum
and proceedings started.
Procedure Related To Approaching Insurance Ombudsman

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Insurance products have many legalities
and terms and conditions which leads to
various issues.
Insurance Ombudsman provides help and
support to policyholders to secure the
investor’s money.
Conclusion

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