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An individual who has a complaint pending with any life insurance or general insurance company, on matters related to life insurance policy, mediclaim, insurance for personal accident, property, vehicle, or other household articles, can approach the insurance ombudsman. The norm is to first approach the insurance company for grievance redressal.
If it fails to respond after a month or gives an unsatisfactory response, the matter can be taken up with the ombudsman. A complainant, whose grievance on the same issue is pending before a court/consumer forum, cannot approach the ombudsman. The complaints pertaining to repudiation of claims, delay in settlement of claims, disputes regarding premium, non-issuance of insurance documents, etc, are entertained by the insurance ombudsman.
Jurisdiction:
The complaint must be filed with the insurance ombudsman under whose jurisdiction the branch or office of the insurer is located. The contact details of the ombudsmen are available on the Website of Irda.
Complaint:
There is no need for a lawyer to file a complaint. It can be sent in writing via post, fax or e-mail. In case an e-mail has been sent, a hard copy must also be sent later. The letter should mention the necessary details.
Settlement:
After agreement between the insurer and the complainant, a recommendation by the ombudsman must be made within one month of filing the complaint. The letter of acceptance, along with the recommendation, is then sent to the insurance company, which must comply within the next 15 days.
Points to note
Upper claim limit:
The maximum limit for the amount under dispute, for which the ombudsman can entertain a complaint, is Rs 20 lakh. If the policyholder is not satisfied with the settlement, he can approach a consumer forum or court for redressal. Insurer's responsibility: Insurers must provide information to the policyholder with regard to the relevant insurance ombudsman along with the policy document.