The #Insurance #Regulatory and Authority of India have set up a procedure for insurance companies to handle customer grievances. If you have any queries or you want to file a complaint, then the insurance company should be the first place you want to visit, but if you aren’t satisfied with the response, you can approach the insurance #ombudsman.

Who is an Insurance Ombudsman?

The Indian Government launched the Insurance Ombudsman scheme to help the policy holders to get their complaints addressed and resolved off the court efficiently and in an unbiased manner.

Who and when can one approach the Insurance Ombudsman?

Any individual policyholder may approach Insurance ombudsman for redressal of their grievance.
There are certain types of complaints for which a policyholder can approach the Insurance Ombudsman. Following are the complaints for which a policyholder can approach:
In case of any delay in the claim settlement, beyond the time limit, stated according to the regulations under IRDAI Act, 1999
Disputes pertaining to premiums payable or paid for life or general insurance policy;
In case of any partial or total rejection of claims by the life insurer or general insurer
Complaints related to the services of policy by an insurance company, an agent or by an intermediary
In case of non-issuance of the insurance policy after receipt of premium by the insurance company. This can be related to the life insurance, health insurance or any other general insurance products;
In case of issuance of insurance policy that is not in compliance with the submitted proposal form. It can be related to the life insurance, health insurance or any other general insurance products;
Any disputes pertaining to the legal construction of insurance policies in so far as such dispute pertains to claim;
Any complaints related to violation of provisions of the Insurance Act, 1938 or the guidelines, regulations and circulars issued by the regulatory body.

Step by Step Procedure for filing complaint with Insurance Ombudsman in India

Filing a Complaint is extremely easy and seamless. The compliant can be filed by the following steps:
In case, one fails to obtain a satisfactory response from the insurance company on their grievances or in case you have not received a response on time, i.e., within a month from the complaint, the complainant can proceed to file a complaint with the Ombudsman.
the complainant can Contact the Insurance Ombudsman office that comes under the purview of hi/her jurisdiction. For instance, if the complainant resides in Bangalore, and the insurance company’s office is located in Mumbai, then he/she can approach the Ombudsman in Bangalore centre for filing the complaint.
A complaint may be filed by sending a letter (hard copy) to the Ombudsman or via fax or mail.
the compliant letter should include all the necessary details like policy number and complaint details. It shall enclose the Enclose the relevant documents as demanded by the Ombudsman and post them to the centre. The documentation requirement may vary depending on the nature or type of the complaint filed.
The complainant can visit the Ombudsman centre and he/she can fill Form P-II and P-III. in case, If the documents are sent by post, the Ombudsman will reach out to the complaint asking to fill out these forms.
Once the complaint is submitted, and documents are also submitted, a date will be fixed by the Ombudsman for hearing.

The Settlement process followed by the Ombudsman

The ombudsman plays the role of a mediator between the policyholder and the insurance company. The ombudsman depends upon the facts to arrive at a fair recommendation. If the complainant is satisfied with the recommendations and accept it as a final settlement, the ombudsman will intimate the insurance company by sending an acceptance letter. which should be complied by within 15 days.

However, if you are not satisfied with the recommendations, the ombudsman shall pass an award within 3 months, which would be binding on the insurer. Afterwards, the insurance company is required to comply with the award within 30 days.

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