BackHow to get your insurance related complaints resolved through ombudsmen
An ombudsman acts as a mediator and arrives at a fair recommendation based on the facts of a dispute. If the policyholder accepts the recommendation as final settlement, the ombudsman informs the company and allows it 15 days to comply
PremiumNEW DELHI: Is your insurance claim settlement delayed? Or is your claim repudiated by your insurer? To make matters worse, is your insurer dilly dallying on your complaints? For these, any other grievances related to insurance, you approach an ombudsman officer to get a solution.
Insurance Regulatory and Development Authority (Irdai) has created Insurance Ombudsman scheme for individual policyholders to help them get their complaints settled out of courts in a cost-effective and unbiased manner.
You can raise a complaint to an insurance ombudsman on following issues:
a) Delay in settlement of claims.
b) Partial or total repudiation of claims by the insurer
c) Dispute regarding premium paid or payable with respect to a policy
d) Misrepresentation of policy terms and conditions in the policy document during any time of the policy tenure
e) Policy servicing related grievances against insurers, their agents and intermediaries.
f) Issuance of any insurance policy which does not confirm with the proposal form submitted by the proposer.
g) Non-issuance of insurance policy after receipt of premium
You should not reach out the ombudsman outright. Approach the insurance company first and wait for 30 days for them to respond. If they reject your complaint, don't give a satisfactory resolution or don’t respond, you can reach out to the ombudsman.
Other conditions are that your complaint relate to any policy that you have taken in your capacity as an individual and that the value of the claim including expenses claimed is not above ₹30 lakh.
The ombudsman acts as a mediator and arrives at a fair recommendation based on the facts of a dispute. If the policyholder accepts the recommendation as final settlement, the ombudsman informs the company and allows it 15 days to comply.
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