Introduction
Office of Insurance Ombudsman, which has been constituted under the Insurance Ombudsman Rules, 2017, is an alternate Grievance
Redressal platform which has been setup with an aim to resolve grievances of aggrieved policyholders against Insurance Companies and
its Intermediaries or Insurance Brokers in a speedy and cost-effective manner. The Offices of Insurance Ombudsman are under the
administrative control of Council for Insurance Ombudsmen (CIO).
How to approach Insurance Ombudsman:
Any aggrieved policyholder who has been issued a policy on personal lines of business, may either himself or through his legal heirs or
nominee or assignee may register a complaint with the Office of Insurance Ombudsman either online or through written communication
through e-mail or letter.
Impartial and timely disposal:
After receipt of all requirements, Insurance Ombudsman shall dispose of the complaint by way of an award within a period of three
months and such decision shall be binding on the Insurance Companies and it’s Intermediaries or Insurance Brokers as the case may be.
To know more about us, kindly refer to section on our website.
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Insurance Ombudsmen are appointed by the Council for Insurance Ombudsmen and are empowered to receive and consider complaints alleging deficiency in
performance required of an insurer (including its agents and intermediaries) or an insurance broker on any of the following:
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(a) delay in settlement of claims, beyond the time specified in the regulations, framed under the Insurance Regulatory and Development Authority of India Act, 1999;
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(b) any partial or total repudiation of claims by the life insurer, general insurer or the health insurer;
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(c) disputes over premium paid or payable in terms of insurance policy;
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(d) misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
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(e) legal construction of insurance policies in so far as the dispute relates to claim;
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(f) policy servicing related grievances against insurers and their agents and intermediaries;
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(g) issuance of life insurance policy, general insurance policy including health insurance policy which is not in conformity with the proposal form submitted by the proposer;
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(h) non-issuance of insurance policy after receipt of premium in life insurance and general insurance including health insurance; and
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(i) any other matter arising from non-observance of or non-adherence to the provisions of any regulations made by the Authority with regard to protection of policyholders' interests or otherwise, or of any circular, guideline or instruction issued by the Authority, or of the terms and conditions of the policy contract, insofar as such matter relates to issues referred to in clauses (a) to (h).
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Highlights of Institution of Insurance Ombudsman:
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17 Ombudsman Centres, covering the country, established in Ahmedabad,Read More...
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17 Ombudsman Centres, covering the country, established in Ahmedabad, Bengaluru, Bhopal, Bhubaneswar, Chandigarh, Chennai, Delhi, Guwahati, Hyderabad, Jaipur, Kochi, Kolkata, Lucknow, Mumbai, Pune, Patna and Noida.
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In the last twenty one years i.e. 01.04.2000 to 31.03.2021, the institution has dealt with 428054 complaints and has given relief to aggrieved claimants.
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Procedure is quick and free of cost.
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Apart from regular hearings at the Centres, Insurance Ombudsmen hold outstation hearings within their territorial jurisdiction for the convenience of complainants. Online hearings are also conducted by the Insurance Ombudsman for the convenience of the complainants.
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Online registration of complaints is introduced from April 2021 whereby the complainant can register his complaint from home.
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With a current complaint disposal rate of 87.34% as on 31.03.2021 the institution has given a good account of itself as an alternate Grievance Redressal Machinery in Insurance Sector.
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CIO works in close co-ordination with LI Council and GI Council at regular intervals.
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CIO believes in a robust corporate governance framework and takes cognizance of risk management components. Read Less...
