The Council for Insurance Ombudsmen (CIO) (formerly ECOI/GBIC) has been established under RPG Rules 1998 & Insurance Ombudsman Rules 2017(as amended till date), to set-up and facilitate the Institution of Insurance Ombudsman in India.
The Council for Insurance Ombudsmen consists of two representatives nominated by the Life Insurance Council, two representatives from General insurers, other than stand-alone health insurers and one representative representing stand-alone health insurers nominated by the General Insurance Council, one representative of the IRDAI and one representative of the Central Government in the Ministry of Finance from the Department of Financial Services not below the rank Joint Secretary or equivalent; and the Chairman, Life Insurance Corporation of India(LIC of India) established under the Life Insurance Corporation Act, 1956( 31 of 1956) or the Chairman, General Insurers' (Public Sector) Association of India (GIPSA) provided they are not acting as Chairperson of the Council for Insurance Ombudsmen.
The Insurance Ombudsman Rules, 2017 (IO Rules - 2017) (as amended from time to time), contain provisions in respect of appointment and office term, etc for Insurance Ombudsman and also include stipulations in respect of staffing and administration of Ombudsman Centre, powers of Ombudsman, manner of lodging complaint and disposal of complaint by Ombudsman either by way of Recommendation or Award. Miscellaneous Provisions of the notification relate to constitution of Advisory Committee, submission of annual report, etc.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:
(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;
(b) any partial or total repudiation of claims by the life insurer, General insurer or the health insurer;
(c) disputes over premium paid or payable in terms of insurance policy;
(d) misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
(e) legal construction of insurance policies in so far as the dispute relates to claim;
(f) policy servicing related grievances against insurers and their agents and intermediaries;
(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;
(h) non-issuance of insurance policy after receipt of premium in life insurance and general insurance including health insurance; and
(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).
* 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.
* 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.
* Procedure is quick and free of cost.
* 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.
* Registration of complaints is introduced from April 2021 whereby the complainant can register his complaint from home.
* 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.
* CIO works in close co-ordination with LI Council and GI Council at regular intervals.
* CIO believes in a robust corporate governance framework and takes cognizance of risk management components.