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The Insurance Ombudsman scheme was created by the IRDAI for individuals who have complaints regarding insurance intermediaries and insurance brokers. The ombudsman helps people to resolve their complaints in a cost-effective and efficient or impartial manner. 

Currently, 17 Insurance Ombudsman offices are located in the different locations of the country. You can submit a complaint to the Insurance Ombudsman through online or offline. They deal with death claims, maturity claims, survival benefits, miscellaneous and mis-selling.

What To Do Before Lodging a Complaint to Insurance Ombudsman?

As per the authority, before submitting a Grievance to the Insurance Ombudsman, it is better to follow these steps:

  • Made a complaint to the Insurance Broker or Insurance Company
  • The Insurance Broker or Insurance Company failed to reply to the complaint within a period of one month or you are not satisfied with the response.
  • The complaint is made to the ombudsman within a year from the date of
    • Rejection of the complaint.
    • Expiry of one month of filing the complaint.
  • The amount of compensation should not exceed Rs. 50 Lakhs.

Which Type of Complaints Lodged with the Insurance Ombudsman?

The Ombudsman resolves the problem related to policies connected with personal lines of insurance, group insurance policies, and policies issued to sole proprietors and micro enterprises

  • Delay in settlement of claims, mentioned under the Insurance Regulatory and Development Authority of India Act, 1999.
  • Disputes over premium paid or payable
  • Misrepresentation of policy terms and conditions 
  • Disputes related to the claim
  • Issuance of life insurance policy, general insurance policy including health insurance policy without the proposal form submitted by the proposer.
  • Non-issuance of insurance policy after receipt of premium

What is the Settlement Process of the Ombudsman?

Any insurance policyholder can reach out to the Ombudsman and he will act as a liaison between you and the policy provider. The procedure of the settlement is as follows:

  • After filing the complaint, the Ombudsman will come to a fair settlement within one month as per the information shared.
  • If you accept the settlement, then the Ombudsman will notify the insurance provider by issuing a letter of acceptance, that must be accepted within 15 days.
  • In case you reject the settlement offer, the Ombudsman will legally enforce the decision on the insurance provider within three months of receiving the required information.
  • The insurance firms have to adhere to the decision of the Insurance Ombudsman within 30 days of receiving the decision.
  • The Ombudsman must be notified if the insurance firm complies with the decision.

How to Track the Status of Complaint?

After filing a complaint to the Insurance Ombudsman, you can track its status. However, most of the time you get the response within one month. But you can check the status if not receive any reply from the ombudsman.

  • Visit the website of CIOINS to track the status.
  • On the Home page click on Track Complaint.
  • Fill in the Mobile Number and OTP. Click on Proceed.
  • The status of the complaint will appear on the screen.

Where is the Ombudsman Office in Delhi?

The process of filing a complaint is completely online, but in case you want to visit the office, then you can find the details of different locations on the CIO (Council for Insurance Ombudsman). The details of the Delhi office are as follows:

Address: 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002.

Tel.: 011 – 23237539

Email: bimalokpal.delhi@cioins.co.in

Jurisdiction: Delhi & following Districts of Haryana – Gurugram, Faridabad, Sonepat & Bahadurgarh.

By Kashish

Content writer with a diverse portfolio spanning various subjects. With a seasoned background, I have been crafting professional content since 2019.

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