Insurance Uncovered

The insurance ombudsman scheme was created by the Government for individual policyholders to have their complaints settled out of the courts system in a cost-effective, efficient and impartial way.

There are ombudsman in different locations and any person who has a grievance against an insurer can himself or through his legal heirs, nominee or assignee, make a complaint in writing to the Insurance ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential address or place of residence of the complainant is located.

You can approach the ombudsman with complaint if:

1. You first approached your insurance company with the complaint and they rejected it, or

2. Not resolved it to your satisfaction, or

3. Not responded to it at all for 30 days, or

4. Your complaint pertains to any policy you have taken in your capacity as an individual and the value of the claim, including expenses, is not above ₹30 lakh

Your complaint to the ombudsman can be about:

1. Delay in settlement of claims, beyond the time specified in the regulations framed under the IRDAI Act, 1999

2. Any partial or total repudiation of claims by the life insurer, general insurer or health insurer

3. Any dispute about premium paid or payable in terms of insurance policy

4. Misrepresentation of policy terms and conditions at any time in the policy document or policy contract

5. Legal construction of insurance policies insofar as the dispute relates to claim

6. Policy servicing-related grievances against insurers and their agents and intermediaries

7. 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

8. Non-issuance of insurance policy after receipt of premium in life insurance and general insurance, including health insurance

Source: IRDAI

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