Topics Covered: Statutory, regulatory and various quasi-judicial bodies.
The government has amended insurance ombudsman rules.
As per the new rules:
- Insurance brokers are now covered under ombudsman rules.
- Policyholders are now allowed to file online complaints.
- The scope of complaints has been enlarged to ombudsmen from only disputes earlier to deficiencies in service on the part of insurers, agents, brokers and other intermediaries.
- The ombudsman may use video-conferencing for hearings.
About Insurance Ombudsman:
The Insurance Ombudsman scheme was created by the Government of India for individual policyholders to have their complaints settled out of the courts system in a cost-effective, efficient and impartial way.
Who can approach?
Any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee, make a complaint in writing to the Insurance ombudsman.
One can approach the Ombudsman with complaint only if:
One has first approached insurance company with the complaint and;
- They have rejected it
- Not resolved it to satisfaction or
- Not responded to it at all for 30 days
And the value of the claim including expenses claimed should not be above Rs 30 lakhs.
Appointment of Ombudsman:
The Ombudsman is a person in the insurance industry, civil or judicial services, and is appointed by the insurance council.
- The serving term of the Insurance Ombudsman is three years.
The settlement process:
The Ombudsman will act as mediator and
- Arrive at a fair recommendation based on the facts of the dispute
- If you accept this as a full and final settlement, the Ombudsman will inform the company which should comply with the terms in 15 days.
If a settlement by recommendation does not work, the Ombudsman will Pass an award within 3 months of receiving all the requirements from the complainant and which will be binding on the insurance company.
Once the Award is passed:
The Insurer shall comply with the award within 30 days of the receipt of award and intimate the compliance of the same to the Ombudsman.
- About the Insurance Ombudsman scheme.
Discuss the roles and functions of Insurance Ombudsman.
Sources: the Hindu.