Last Updated on June 21, 2024 by Satish Mishra
Insurance Ombudsman Rules, 2017 have been formulated by the government for quick resolution of disputes amongst insurance companies and consumers.
Procedure to lodge a complaint with the insurance ombudsman
1. The award of insurance ombudsman is binding on the insurance company and they can’t challenge it before any court of law whereas consumers can assail the award before the High Court or the Consumer Court if not satisfied with the order.
2. One can file the claim within the territorial jurisdiction of the ombudsman as found on the irdai.gov.in website.
3. Complaints of the following nature are entertained:
a. Delay in settlement of claim beyond IRDAI Act, 1999.
b. Partial or total repudiation of claims.
c. Misrepresentation of policy terms and conditions at any time in the policy document.
d. Disputes of premium paid.
e. Legal construction of policy.
f. Issuing insurance policy not in conformity with the proposal form.
g. Non issuance of policy after getting premium.
h. Any other matter pertaining to Insurance Act, 1938.
4. The limitation period for filing the complaint before the insurer is one year. When the insurance is rejected, and the reply is not given, the insurance ombudsman may condone the delay if he is satisfied.
5. Pecuniary jurisdiction it insurance ombudsman is Rs. 30 Lakhs only and the award can not exceed the same.
Also Read- BEST EXAMPLES OF CONSUMER COMPLAINTS
6. A consumer cannot file two complaints simultaneously i.e. one before the consumer forum and another with the ombudsman.
7. The decision had to come within 3 months by the ombudsman once all the requirements are complete.
8. No fees or cheques are to be paid for lodging complaint with the insurance ombudsman.
9. Insurance ombudsman can only pass an award after giving a reasonable opportunity to both the parties.
10. Only a consumer can prefer an appeal against the award and not the insurer.
Also Read- COMPANY REFUSING TO PAY HEALTH INSURANCE? REMEDY IS WITH CONSUMER COURT
11. Insurance companies have to comply the award within thirty days of receipt of award and communicate the same to the ombudsman office.
12. Complaints can be lodged against both public and private sector insurance companies.
13. Insurance ombudsman are discharging the services under the provisions of the Redressal of Public Grievance Rules, 1998; which were framed under section 114(1) of the Insurance Act, 1938.
14. Further, if your claim is dismissed before the insurance ombudsman, a consumer can still approach the consumer court or high court for remedy.
15. The role of insurance ombudsman is quasi-judicial in nature, and hence can accept evidence on record. Presently, there are 17 insurance ombudsman in our country.
Also Read- CONSUMER COURT- A QUICK GUIDE FOR TRICITY
These fifteen pointers are enough for you to understand how insurance ombudsman works in Chandigarh. The jurisdiction spreads across to Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir and Chandigarh.
Address: Office of Insurance Ombudsman, SCO no. 101, 102 and 103, Second Floor, Batra building, sector 17D, Chandigarh (160017).
Rest you can always take the help of the best/top/expert insurance ombudsman lawyer/advocate in Chandigarh Panchkula Mohali (Punjab & Haryana ) for your case.
Also Read- LEGAL NOTICE BEFORE CONSUMER COMPLAINT
For more information, please dial 9988817966.
