Insurance ombudsman is responsible for protecting the interests and settling grievances of policy holders.The main objective behind appointing ombudsman is to settle the grievances and complaints of policy holders outside court system in a cost-effective, efficient and impartial manner.
There are 12 insurance ombudsmen across India. (See the list of insurance ombudsman here.)
Who appoints insurance ombudsman?
The governing body of insurance council appoints ombudsman on the recommendations of a committee comprising chairperson of IRDA, two representatives from each insurance councils of life insurance business and general insurance business and any one representative from the central government.Ombudsman is appointed either from insurance sector, civil service or judicial service.
Ombudsman is appointed for a tenure of three years. Ombudsman could be removed for anymisconduct, committed during his/her tenure. Reappointment of ombudsman is not permitted.
Complaints
Policy holders can lodge their complaints online through www.igms.irda.gov.in. However, the aggrieved policy holders can’t approach the ombudsman directly. They have to first lodge their complaints with the insurers. If the insurance company doesn’t respond to a complaint within 30 days or if the policyholder is not satisfied with the response, policyholders can approach the insurance ombudsman. The ombudsman accepts written complaints only.
Disputes related to claim settlement, mis-selling, premium payment, legal construction of policy wordings, delay in settlements, non-issuance of insurance documents are some of the areas which ombudsman look into. Ombudsman can only award a claim up to Rs 20 lakh.
The complainant has to accept the recommendations of the ombudsman within 15 days from the date of receipt of the recommendation.The insurer is required to comply with the recommendations of the ombudsman within 15 days. If the policy holder is not satisfied with the award of the ombudsman, he/she can approach other authorities like consumer forums and courts of law. An ombudsman is supposed to pass an award within three months after receiving a complaint from policyholders. The ombudsman can also award an ex-gratia payment.