Who is an Insurance Ombudsman? What are the Roles and Powers of an Insurance Ombudsman?

Insurance is a contract between the Insurer and the Insured. The insured is generally a common person and the insured is a large-scale company with unlimited resources. No insurance company settles 100% of the claims it receives. In many cases, a large portion of the claims get rejected. Hence, the disgruntled insured has no other option but to approach the courts to get proper relief. Hence, the insured person, who has already paid the premium, is forced to spend more money and time to get his rightful claim. Thus, to alleviate this pain the Honorable Government of India has introduced a  Ombudsman System to deal with these issues in the year 2017 through The Insurance Ombudsman Rules.

What kinds of policies are covered under these Rules?

The Insurance Ombudsman Rules do not apply to all kinds of insurance. The rules applies to all insurance Given or Taken in an Individual Capacity. Also, it covers group insurance obtained, through an employer or otherwise, by Sole Proprietorships or Micro Enterprises.

Can we file a complaint against an Agent?

The agent is an important part of the Insurance Infrastructure and Environment. Also, the remuneration of most agents depends on the number of insurances they sell. Hence, it is observed that they often make false representations about the policies. Thus, the aggrieved insured person can file a complaint against the insurance company and the insurance agent.

What kinds of complaints are dealt with by the Insurance Ombudsman?

The Insurance Ombudsman will deal with the following complaints:-

  • The non-settlement of claims after 30 days of filing the same with the Insurer.
  • Rejection of claims by the Insurer.
  • Misrepresentations made by the Insurer or the agents.
  • Insurance policy not issued even after payment of premium.
  • Insurance policy not in accordance with proposal forms.
  •  Any other matter in abrogation of the law or the terms of the policy.


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