Important Points : Before filing complaint in Ombudsman
1- The Insurance Ombudsman will not accept your complaint until you have first filed a complaint with IRDA. IRDA will not accept your complaint until you have first filed a complaint with your Insurance Company.
2- Please note that all complaints have to be clearly marked as complaint and should not be mere requests.
3- You must file the complaint with the ombudsman within a year of the rejection of your claim by the insurer.
4- The ombudsman intervenes only if you’ve not moved any court or approached a consumer forum.
5- Ombudsman’s powers are restricted to insurance contracts of value not exceeding Rs. 20 lakhs.
When can you file an complaint in Ombudsmen?
(i) The complainant should have made a representation to the insurer named in the complaint and the insurer either should have rejected the complaint or the complainant have not received any reply within a period of one month after the concerned insurer has received his complaint or he is not satisfied with the reply of the insurer.
(ii) The complaint is not made later than one year after the insurer had replied.
(iii) The same complaint on the subject should not be pending with before any court, consumer forum or arbitrator.
How to file a complaint
There is no prescribed format for filing complaints. All it requires is for you to submit your complaint in writing, stating the facts, with documentary proof to back your claim. If your complaint is taken up, the settlement process will get under way without even requiring your presence.
The ombudsman shall pass an award within a period of three months from the receipt of the complaint. The awards are binding upon the insurance companies.
What all complaint can I file?
The complaint may relate to any grievance against the insurer i.e.
(a) Any partial or total repudiation of claims by the insurance companies,
(b) Dispute with regard to premium paid or payable in terms of the policy,
(c) Dispute on the legal construction of the policy wordings in case such dispute relates to claims;
(d) Delay in settlement of claims and
(e) Non-issuance of any insurance document to customers after receipt of premium.
List of Insurance Ombudsmen in India – Link
If the policy holder is not satisfied with the award of the Ombudsman he can approach other venues like Consumer Forums and Courts of law for redressal of his grievances.
Step 1 - How to file an Appeal against Insurance Claim Denial?
Step 2 - How to file a complaint to IRDA for an Insurance Claim?
Step 3 - How to file a Complaint to Insurance Ombudsman?
Step 4 - How to file an Insurance Claim Complaint to Consumer Court?