Now Insurance related complain solved in 3 months.

To resolve insurance-related disputes, there are twelve ombudsmen across the country. The offices of the twelve insurance ombudsmen are located at Bhopal, Bhubaneswar, Cochin, Guwahati, Chandigarh, New Delhi, Chennai, Kolkata, Ahmedabad, Lucknow, Mumbai, and Hyderabad. According to the policyholder protection regulations, every insurer is expected to inform the policyholder about the insurance ombudsman under whose jurisdiction his office falls for the purpose of any grievances redressal.

Power of Ombudsman:

The insurance ombudsman has two types of functions to perform – conciliation and award-making.

The insurance ombudsman is empowered to receive and consider complaints from anyone who has a grievance against an insurer. The complaint may relate to any partial or total repudiation of claims by the insurance companies, disputes with regard to premium paid or payable in terms of the policy, disputes on the legal construction of the policy wordings in case such dispute relates to claims, delay in settlement of claims and non-issuance of any insurance document after receipt of premium.

But the point to note is that ombudsman’s powers are restricted to insurance contracts of value not exceeding Rs. 20 lakh. The insurance companies are required to honour the awards passed by an insurance ombudsman within three months.

Manner of lodging complaint:

The complaint has to be in writing, and addressed to the insurance ombudsman of the jurisdiction under which the office of the insurer falls.

The complaint can also be lodged through the legal heirs of the insured. But you cannot approach the ombudsman right away. Before lodging a complaint, you should have made a representation to your insurer and the insurer should either have rejected the complaint or not replied within a period of one month or made an unsatisfactory reply.

The complaint to the ombudsman should not be made later than one year after the insurer has replied and the same complaint on the subject should not be pending before any court, consumer forum or arbitrator.

When a complaint is settled through the mediation of the ombudsman, he shall make the recommendations which he thinks fair under the circumstances of the case. Such a recommendation shall be made not later than one month and copies of the settlement will be sent to you and to the insurance company concerned. If you accept the recommendations, you need to send a communication in writing accepting the settlement within 15 days of receipt.

Award

The ombudsman will pass an award within a period of three months from the receipt of the complaint. The awards are binding upon the insurance companies.

If you are not satisfied with the award of the ombudsman, you can approach other forums like consumer courts and courts of law for redressal of grievances.