Disgruntled customers can bring down institutions, brands and products.
Organizations therefore take utmost care in laying out detailed guidelines for “grievance redressal”.
Arbitrators or ombudsmen are appointed for looking into contentious issues which cannot be resolved at the lower level.
They act as a referee and try to reconcile the misgivings which the customer may be facing.
For Insurance companies the role of the arbitrator is all the more important as the product is of intangible nature.
The Insurance Ombudsman, as he is called, is vested with powers to handle disputes based on laid down rules and policies.
The Insurance Ombudsman in India functions as a cost-free and impartial grievance redressal mechanism between policyholders and insurance companies.
It was established under the Redressal of Public Grievances Rules, 1998 to resolve issues such as claim rejections, premium disputes, and policy delays fairly and efficiently.
Customers often face problems regarding their claims, premium payments and policy documents .
In case of any grievance, they need to contact the concerned insurance office and lodge a complaint.
If no response is received within 30 days, or if the response received is not to the satisfaction of the customer, then he or she may approach an insurance ombudsman.
The functions of the insurance ombudsman include examining complaints, mediating disputes, and issuing awards up to ₹20 lakh.
This process ensures transparency, fairness, and consumer protection within the insurance sector.
On the 11th of November 1998, the Government of India, set up the post of ombudsman with the aim of fostering trust between the insured and the insurer.
The role of facilitator for dispute resolution and protection of customer rights are performed by the ombudsman.
The customer or complainant has to perform the following steps before they can approach the ombudsman:
i. File complaint with the insurance company either through written communication, fax or email.
ii. Complaint is filed but no response is received within 30 days
iii. Complaint is filed but the response received is not satisfactory
iv. Complaint has not already been filed with any other body like a consumer forum or court.
To file a complaint with the Insurance Ombudsman, policyholders can submit their application online through the BIMA BHAROSA portal, send it by email, or deliver it in person to the Ombudsman office.
All relevant documents such as policy details, claim letters, and insurer responses must be enclosed for faster resolution.
Once these conditions have been satisfied and the customer’s issue has still not been addressed up to his satisfaction, the customer can approach the ombudsman either through written application, fax or mail.
Across India, there are 12 ombudsman offices which are divided into different zones.
It is however not necessary that one office is limited to a single state only.
Complaint needs to be lodged with the ombudsman office under whose jurisdiction the insurance office falls.
Currently, there are 17 Insurance Ombudsman offices in India located across major cities such as Chennai, Delhi, Mumbai, Hyderabad, and Kolkata.
Each office handles complaints from specific regional jurisdictions.
The updated Insurance Ombudsman list and jurisdiction map are available on the IRDAI website.
The issues which can be taken to the ombudsman for redressal are:
i. The policy document is not received by the customer even after successfully making the premium payment.
ii. Claim lodged by the customer is rejected without valid reason by the insurance company
iii. Non-payment of the claim amount after having accepted the claim.
iv. Any disagreement arising regarding payment of premium amount as against payable amount
v. Issues relating to terms and conditions of the policy
vi. Delay in claim processing
A complaint to the Insurance Ombudsman must be filed within one year from the insurer’s final written response or within one year after the expiry of 30 days if no reply is received.
The Ombudsman will not entertain matters already before any consumer forum or court of law.
The ombudsman has the authority to settle disputes on insurance matters for all claims up to the amount of Rs. 20.00 lakhs.
The verdict or decision of the ombudsman has to be conveyed to the customer within three months of having received the complaint.
Insurance companies are bound to abide by his decisions.
While the IRDAI’s Integrated Grievance Management System (IGMS) helps policyholders register and track complaints online, the Insurance Ombudsman provides a quasi-judicial and region-specific mechanism for direct resolution.
Both systems work together to improve the efficiency and transparency of insurance grievance handling in India.
In case the customer does not agree with the decision of the ombudsman, he can approach the consumer forum or take legal recourse for settling his grievance.
The insurance ombudsman system strengthens consumer protection by offering an affordable, fast, and transparent way to resolve disputes.
It encourages trust between insurers and policyholders while ensuring accountability within the insurance ecosystem.
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