Insurance Ombudsman Case Study

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Insurance Ombudsman: The institution of Insurance Ombudsman was created by a Government of India Notification dated 11th November, 1998. The purpose of creation was: 1. Quick disposal of the grievances of the insured customers 2. To mitigate the problems faced by customers involved in redressal of grievances Ombudsman are drawn from Insurance Industry, Civil Services and Judicial Services by the governing body of insurance council. An insurance Ombudsman is appointed for a term of three years or till the person attains the age of 65 years, whichever is earlier. Re-appointment is not allowed. The governing body of IRDA appoints twelve Ombudsman across the country allotting them different geographical areas as their areas of jurisdiction. The…show more content…
The following grievances against the insurer can be taken by ombudsman: 1. Any partial or total repudiation of claims by the insurance companies 2. Dispute with regard to premium paid or payable in terms of the policy 3. Dispute on the legal construction of the policy wordings where such dispute relates to claims 4. Delay in settlement of claims 5. Non-issuance of any insurance document to customers after receiving the premium Ombudsman's powers are restricted to insurance of value upto Rs. 20 lakh. The insurance companies are required to honour the awards passed by an Insurance Ombudsman within 3 months. Complaint Lodging Process : The complaint has to be in writing, addressed to the insurance Ombudsman of the jurisdiction under which the office of the insurer comes. The complaint can also be lodged by the legal heirs of the insured. Following should be checked before lodging a complaint : a) The complainant should have made a representation to the…show more content…
Recommendations: When a complaint is settled through the mediation of the Insurance Ombudsman, He shall make the recommendations which he thinks fair in the circumstances of the case. Recommendations should be made within one month and copies of the same must be sent to complainant and the insurance company If the complainant accepts recommendations, he/she will require to send a communication in writing accepting the settlement within 15 days of the date of receipt. Award: The ombudsman shall pass an award within a period of three months from the receipt of the complaint. The awards are binding upon the insurance companies. If the policy holder is not satisfied with the award given by the Ombudsman, he/she can approach other venues like Consumer Forums and Courts of law for redressal of his/her grievances. During 2013-14, The 12 Ombudsmen centre had received a total of 26315 complaints. While 67 per cent (17512 complaints) pertained to life insurers, the remaining 33 percent (8803 complaints) related to non-life insurers. Additionally 8601 complaints were pending with various offices of Ombudsmen as at the end of March 2013. The offices of Ombudsmen have handled a total of 34916 cases during
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