General

Insurance Ombudsman

The insurance world is very complex, filled with complex terms, complicated policies and sometimes frustrating encounters with unpredictable situations. In this confusion, the Insurance Ombudsman can…

The insurance world is very complex, filled with complex terms, complicated policies and sometimes frustrating encounters with unpredictable situations. In this confusion, the Insurance Ombudsman can be a saviour for the policyholders. This unbiased custodian of policyholders' rights is your advocate, a champion against unfair practices and the voice of justice when disputes arise.

Understanding the Role of the Insurance Ombudsman

The Insurance Regulatory and Development Authority of India (IRDAI) established the Insurance Ombudsman. The Insurance Ombudsman provides a faster and cheaper platform to resolve disputes between insurance companies and policyholders. The insurance ombudsman empowers policyholders to seek redressal of grievances related to:

  • Claim settlements and rejections.
  • Policy issuance and renewal issues.
  • Misleading or false information provided by the insurance company.
  • Delays in processing claims or payments.
  • Unfair terms and conditions within the policy.
  • Misleading advertising and marketing of insurance products.

Key Features of the Insurance Ombudsman

Below, we have mentioned the key features of the Insurance Ombudsman:

  • Accessibility: The Ombudsman is available to all policyholders, irrespective of their claim amount or location. Complaints can also be filed online, through post, or in person at designated offices.
  • Cost-effectiveness: Filing a complaint with the Ombudsman is free, making it a viable option for policyholders who need more financial resources to seek legal recourse.
  • Time-bound Process: The Insurance Ombudsman mandates a time-bound resolution process, with most cases being disposed of within 3 months. This ensures quick resolution for policyholders who often face financial difficulty due to insurance issues.
  • Informal and Fair: The Insurance Ombudsman is informal and avoids the complexities of legal proceedings. Both sides can present their case, ensuring a fair and transparent process.

Powers of Insurance Ombudsman

The Insurance Ombudsman has two main functions: conciliation and award-making. The organization takes care of customers’ complaints about any issue against the services provided by any insurance company. These issues include:

  • Any partial or complete rejection of claims 
  • Disputes involving paid or due premiums
  • Disputes regarding the policy wording
  • Delays in claims resolution
  • Despite receiving the premium payment, the insurance paperwork relating to the policy has yet to be issued.

List of Insurance Ombudsman Offices in India

Below-mentioned is the list of Insurance Ombudsman available in India:

State

Insurance Ombudsman Office Address 

Telephone No.

Email ID

Ahmedabad

Jeevan Prakash Building, 6th Floor, Tilak Marg, Relief Road, Ahmedabad-380001

Tel.: 07927546139/150

Email: bimalokpal.ahmedabad@ecoi.co.in

Bengaluru

Jeevan Soudha Building, PID No. 57-27-N-19, Ground Floor, 19/19, 24th Main Road, JP Nagar, 1stPhase, Bengaluru-560078

Tel.: 080-26652048/49

Email: bimalokpal.bengaluru@ecoi.co.in

Bhopal

Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Opposite Airtel Office, Near New Market, Bhopal-462003

Tel.: 0755-2769200/201/202

Fax: 0755-2769203

Email: bimalokpal.bhopal@ecoi.co.in

Bhubaneshwar

62, Forest Park, Bhubaneswar-751009

Tel.: 0674-2596461/455

Fax: 0674-2596429

Email: bimalokpal.bhubaneswar@ecoi.co.in

Chandigarh

SCO No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17 – D,

Chandigarh-160017

Tel.: 0172-2706196/468

Fax: 0172-2708274

Email: bimalokpal.chandigarh@ecoi.co.in

Chennai

Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, Chennai-600018

Tel.: 044-24333668/24335284

Fax: 044-24333664

Email: bimalokpal.chennai@ecoi.co.in

Delhi

2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi-110002

Tel.: 011-23232481/23213504

Email: bimalokpal.delhi@ecoi.co.in

Guwahati

Jeevan Nivesh, 5th Floor, Nr. Panbazar Over Bridge, S.S. Road, Guwahati-781001(Assam)

Tel.: 0361-2632204/2602205

Email: bimalokpal.guwahati@ecoi.co.in

Hyderabad

6-2-46, 1st floor, “Moin Court”, Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad-500004

Tel.: 040-67504123/23312122

Fax: 040-23376599

Email: bimalokpal.hyderabad@ecoi.co.in

Jaipur

Jeevan Nidhi – II Bldg., Ground Floor, Bhawani Singh Marg, Jaipur-302005

Tel.: 0141-2740363

Email: Bimalokpal.jaipur@ecoi.co.in

Ernakulam

2nd Floor, Pulinat Building,

Opposite Cochin Shipyard, MG Road, Ernakulam-682015

Tel.: 0484-2358759/2359338

Fax: 0484 – 2359336

Email: bimalokpal.ernakulam@ecoi.co.in

Kolkata

Hindustan Building, Annexe, 4th Floor, 4, CR Avenue, Kolkata-700072

Tel.: 033-22124339/340

Fax: 033 – 22124341

Email: bimalokpal.kolkata@ecoi.co.in

Lucknow

6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow-226001

Tel.: 0522-2231330/331

Fax: 0522-2231310

Email: bimalokpal.lucknow@ecoi.co.in

Mumbai

3rd Floor, Jeevan Seva Annexe, SV Road, Santacruz (W), Mumbai – 400054

Tel.: 022-26106552 / 26106960

Fax: 022-26106052

Email: bimalokpal.mumbai@ecoi.co.in

Noida

Bhagwan Sahai Palace, 4th Floor, Main Road, Naya Bans, Sector 15, District Gautam Buddh Nagar, UP-201301

Tel.: 0120-2514250/252/253

Email: bimalokpal.noida@ecoi.co.in

Patna

1st Floor, Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur, Patna- 800006

Tel.: 0612-2680952

Email: bimalokpal.patna@ecoi.co.in

Pune

Jeevan Darshan Building, 3rdFloor, CTS No. 195 To 198, NC Kelkar Road, Narayan Peth, Pune-411030

Tel.: 020-41312555

Email: bimalokpal.pune@ecoi.co.in

When to Approach the Insurance Ombudsman?

Suppose you are facing an issue with your insurance provider regarding your claim rejection or claim delay. In that case, you can escalate it to the Insurance ombudsman in the below-mentioned circumstances:

  • If your complaint was initially lodged with your insurance provider, but it was either rejected, unanswered for 30 days or not adequately resolved.
  • Your complaint pertains to your life insurance coverage.
  • The value of your life insurance claim should be under INR 30 lakhs.

To file a complaint with the Insurance Ombudsman, you must submit a written complaint in a prescribed complaint form. You can submit the complaint in person or through a letter, fax, or email. However, if you choose to submit the complaint via email, attaching a hard copy of the complaint is mandatory. It's important to note that you must file the insurance claim within one year of the insurer's rejection. Furthermore, the ombudsman will not handle a court case or consumer forum already dealing with the same complaint.

Process For Lodging A Complaint With Insurance Ombudsman

Below, we have mentioned the process to file a complaint with the insurance ombudsman:

  • Connect with the nearest Insurance Ombudsman office. 
  • Send a hard copy of the complaint to the Insurance Ombudsman to file your complaint using the procedure for complaints. Moreover, You can also send your grievance via fax or email.
  • The complaint must contain all appropriate information, such as details on the policy issue, the paid and unpaid premiums, the complaint in detail, the actions the insurance company took, etc. To the Insurance Ombudsman office in your area.
  • After registering your complaint to the insurance ombudsman, you must fill out P-II and P-III forms. 
  • Then, you need to mail these documents along with your complaint to the Insurance Ombudsman.
  • Once the Ombudsman will get all the documents, they will announce a hearing date.

Types Of Complaints That The Insurance Ombudsman Will Accept

The Insurance Ombudsman can handle a wide range of complaints related to life insurance policies with a claim value of up to INR 30 lakhs. Here's a breakdown of the types of complaints typically accepted:

  • Claim rejection: If your insurance company has rejected your claim, you can seek the Ombudsman's intervention.
  • Partial claim settlement: Even if your claim is partially settled, but you believe the amount is inadequate, the Ombudsman can help.
  • Delays in claim settlement: If your claim settlement is unreasonably delayed, you can file a complaint.
  • Unfair claim terms or conditions: If you believe the claim terms or conditions are unfair or ambiguous, the Ombudsman can review them. 
  • Mis-selling of policies: If you were misled or misinformed about a policy before purchasing it, the Ombudsman can investigate.
  • Non-disclosure of policy terms: If the insurer fails to disclose important information about the policy, you can file a complaint.
  • Unfair policy terms and conditions: If you believe certain policy terms are unfair or unreasonable, the Ombudsman can assess them.
  • Premium disputes: If there are disagreements regarding premium payments or charges, the Ombudsman can mediate.
  • Poor customer service: If you've experienced rude or unresponsive customer service from the insurer, you can file a complaint.
  • Misrepresentation of information: If the insurer provides false or misleading information about the policy or claim process, it can be addressed by the Ombudsman.
  • Delay in policy issuance or renewal: Failure in issuing or renewing your policy can be investigated by the Ombudsman.

Settlement Process With Insurance Ombudsman

The settlement process with the Insurance Ombudsman typically unfolds in the following steps:

  • Get a complaint form from the Ombudsman's website or office and fill it out correctly.
  • Attach the required documents like policy documents, claim rejection letters, correspondence with the insurer, etc.
  • Submit the complaint by mail, fax, or email (with a paper copy attached).
  • The Ombudsman's office will acknowledge receipt of your complaint and assign it to a designated officer.
  • This Ombudsman officer will investigate the whole case.
  • The Ombudsman officer will review both sides of the case, including your complaint, the insurance company's response, and any supporting documents.
  • Both parties are typically bound to comply with the Ombudsman's recommendation unless there are valid reasons for objection.
  • If mediation fails, the Ombudsman may decide to dismiss the complaint, refer it to another forum (court, consumer forum), or issue binding instructions to the insurance company.
  • The case will be closed once the complaint is resolved and both parties are satisfied.

Conclusion

The Insurance Ombudsman is important in empowering policyholders and ensuring a fair and balanced insurance market. By understanding its functions, limitations, and potential for improvement, we can strengthen this important protection for policyholders, ensuring they get the protection and justice they deserve in the complex world of insurance.

Insurance Ombudsman FAQs

  1. What is the Insurance Ombudsman?

Ans. The Insurance Ombudsman is an independent authority established to resolve disputes between policyholders and their insurance companies. This body aims to offer a quick, cost-effective, and impartial way to address grievances related to life insurance policies with claim values up to INR 30 lakhs.

  1. What types of complaints can I file with the Ombudsman?

Ans. You can file complaints about various issues, including:

  • Claim settlement: Claim rejection, partial settlement, delays, unfair terms, etc.
  • Policy issues: Mis-selling, non-disclosure of information, unfair terms, premium disputes, etc.
  • Service issues: Poor customer service, misrepresentation of information, delays in policy issuance or renewal, etc.
  1. What are the eligibility criteria for filing a complaint with the Ombudsman?

Ans. To file a complaint:

  • Your grievance must be related to a life insurance policy.
  • The claim value should be under INR 30 lakhs.
  • You must have already filed a complaint with your insurance provider and received an unsatisfactory response (rejection, no response within 30 days, or inadequate resolution).
  • You must file the complaint within one year of the claim rejection.
  1. How do I file a complaint with the Ombudsman?

Ans. You can file your complaint in person, by mail, fax, or email (with a paper copy attached) to the designated office of the Insurance Ombudsman. You can also download the complaint form from their website.

  1. What happens after I file my complaint?

Ans. The Ombudsman will review your complaint and, if necessary, request additional information from you and the insurance company. They will then try to reach an amicable settlement through mediation. If mediation fails, the Ombudsman may issue a recommendation or dismiss the complaint.

  1. Are there any fees involved in filing a complaint with the Ombudsman?

Ans. There are no fees for filing a complaint with the Insurance Ombudsman. The services are completely free for policyholders.

  1. What if I need legal advice?

Ans. You can seek legal advice at any stage of the process if necessary.

  1. Where can I find more information about the Insurance Ombudsman?

Ans. You can find more information on the website of the Insurance Regulatory and Development Authority of India (IRDAI): https://irdai.gov.in/ombudsman


 

Schema
Last updated on