We all need a friend who listens to our grievances and helps us fight our battles. In the complex insurance world, grievances often go unheard, leaving policyholders feeling frustrated and helpless. Fortunately, the Insurance Ombudsman is here to serve as that trusted friend, guiding you through the intricate landscape of insurance and mediating disputes with insurance companies.
The role of the Insurance Ombudsman was established in India to provide a structured and accessible platform for resolving insurance-related grievances. This system ensures that policyholders have a reliable ally to turn to when they encounter issues with their insurance policies. Whether it’s a dispute over claim settlement, policy terms, or service deficiencies, the Ombudsman is equipped to address and resolve these concerns impartially and efficiently. Let’s explore the role in depth.
What is the Insurance Ombudsman?
The Insurance Ombudsman is an independent and impartial authority appointed to resolve policyholder grievances against insurance companies in a fair and expeditious manner. Established under the Redressal of Public Grievances Rules, 1998, the office of the Insurance Ombudsman functions under the supervision of the Insurance Regulatory and Development Authority of India (IRDAI).
Objectives of the Insurance Ombudsman
Fair Resolution of Complaints: To provide an unbiased platform for the resolution of insurance complaints.
Quick Disposal of Cases: To ensure that complaints are addressed promptly and efficiently.
Reduction of Litigation: To minimise the need for policyholders to resort to courts for resolving disputes.
Improved Customer Confidence: To enhance trust and confidence in the insurance industry by ensuring fair treatment of policyholders.
Scope and Jurisdiction
The Insurance Ombudsman can address complaints from individuals or groups of individuals against any insurance company operating in India. The jurisdiction of the Ombudsman includes complaints related to:
Delay in settlement of claims
Any partial or total repudiation of claims
Disputes over premiums paid or payable
Misrepresentation of policy terms
The legal construction of insurance policies related to claim
Policy serving issues
Non-issuance of insurance documents
Issuance of the policy not in conformity with the proposal form
Violation of provisions of the Insurance Act, 1938 or the regulations, circulars, guidelines or instructions issued by the IRDAI
How to File a Complaint with the Insurance Ombudsman
Filing a complaint with the Insurance Ombudsman is a straightforward process. Here are the steps involved:
Preliminary Steps:
Attempt to resolve the issue directly with the insurance company by submitting a written complaint.
If the insurance company does not respond within 30 days, or if the response is unsatisfactory, you can escalate the matter to the Insurance Ombudsman.
Filing the Complaint:
The complaint must be submitted in writing, either through a letter or email.
The complaint should include all relevant details such as policy number, claim details, and correspondence with the insurance company.
Supporting Documents:
Attach copies of all relevant documents, including the policy, correspondence, and any other evidence supporting your complaint.
Submit to the Appropriate Office:
Submit the complaint to the office of the Insurance Ombudsman having jurisdiction over the location of the insurer’s office or the policyholder’s residence.
Conclusion
The Insurance Ombudsman in India plays a crucial role in protecting the rights of policyholders and ensuring fair treatment by insurance companies. By providing a cost-effective, accessible, and efficient dispute-resolution tool, the Ombudsman enhances confidence in the insurance sector. Understanding the role and functioning of the Insurance Ombudsman can empower policyholders to seek justice and ensure their grievances are addressed promptly and fairly.
