New Delhi: Is your insurance claim settlement getting delayed? Or has your claim been rejected by your insurer? To make matters worse, is your insurer being lax on your complaints? For these, any other complaint related to insurance, you should contact any Ombudsman officer for resolution.
Insurance Regulatory and Development Authority (Irdai) has formulated an Insurance Ombudsman Scheme for individual policyholders to deal with their grievances in a cost-effective and fair manner through the courts.
You can file a complaint with the Insurance Ombudsman on the following issues:
a) Delay in settlement of claims.
b) Partial or total rejection of claims by the insurer
c) Disputes in respect of premium paid or payable in respect of the policy
d) Misrepresentation of policy terms and conditions in the policy document during any time of the policy term
e) Complaints regarding policy servicing against insurers, their agents and intermediaries.
f) Issuance of any insurance policy which does not confirm the offer form submitted by the proposer.
g) Non-issuance of insurance policy after receipt of premium
You should not approach the Ombudsman directly. Contact the insurance company first and wait for 30 days for their reply. If they reject your complaint, do not provide a satisfactory resolution or do not respond, you can approach the Ombudsman.
Other conditions are that your complaint relates to any policy that you have taken in your capacity as an individual and that the value of the claim including the expenses claimed is not above 30 million.
The Ombudsman acts as an arbitrator and arrives at an appropriate recommendation based on the facts of the dispute. If the policyholder accepts the recommendation as a final settlement, the Ombudsman notifies the company and allows 15 days to comply.
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