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What is the time limit for approaching an insurance ombudsman?

 

There are rare occasions where you are not satisfied with the grievances redressal of your insurance company. On these rare occasions, you may want to escalate your issue to a higher forum. The Insurance Ombudsman was formed with exactly this in mind. The Insurance Ombudsman looks after the interests of the policyholders and provides arbitration and resolution services.

That being said, one must be cognizant of the time limit for approaching an insurance ombudsman, and ensure that their case is raised within the stipulated time limit.

In this article, we will cover all the nitty-gritty of how you can approach the insurance ombudsman with your complaint and get a resolution.

This article will be covering the following:

  • What is an Insurance Ombudsman?
  • Where can you find the Insurance Ombudsman?
  • Who can approach the Insurance ombudsman?
  • When can you approach the Insurance Ombudsman?
  • What are the steps to follow while approaching the Insurance ombudsman?
  • What is the time limit for approaching the Insurance Ombudsman?

What is an Insurance ombudsman?

The Institution of Insurance Ombudsman was formed by the Government of India in November 1998.
Its main objective is to handle customer grievances systematically and bring fair resolution. The policyholders can get their complaints resolved in an unprejudiced and efficient manner.

Location of Insurance Ombudsman

There are 17 main insurance ombudsmen offices located in India. The website of IRDA mentions all the details and contact information of all the Ombudsman centers. An aggrieved policyholder can accordingly choose to visit the nearest insurance ombudsman center.

Who can approach Insurance Ombudsman?

Any policyholder, their legal heirs, or nominees can approach the insurance ombudsman to file their complaints.

When can you approach the Insurance Ombudsman?

If a policyholder has approached his insurance company and they were not satisfied with the resolution provided by the company, the policyholder can approach the Insurance Ombudsman within 30 days of the initial grievance.

You can approach the Insurance Ombudsman for the following reasons:

Any issues about the violation of provisions of the Insurance Act 1938 or the guidelines and regulations issued by the Insurance Regulatory and Development Authority (IRDA)

  1. Total or limited rejection of your claims.
  2. Any matter related to premiums payable or paid.
  3. Holding up the claim process.
  4. Not providing the policy documents to the policyholder after the premium has been paid.

Steps to be taken while approaching the Insurance Ombudsman?

Step 1 – As mentioned above, if you have already addressed your grievances with the insurance company and are not satisfied with the outcome, you can approach the insurance ombudsman within 30 days of your issue.

Step 2 – You can get in contact with the Insurance Ombudsman center in your jurisdiction.

For Instance, if the policyholder is staying in Mumbai and his insurance company is located in Mumbai, he may file a complaint with the Insurance Ombudsman center located in Mumbai.

Step 3 – You must register a written complaint by writing a letter to the Insurance Ombudsman. You could also email your complaints to the Ombudsman, but you would also need to send a formal letter to them.

Step 4 – All valid and important information must be provided in the letter. Details such as name, policy number, date of the policy, etc.
You must provide a detailed explanation of your grievances and the details surrounding them. Also, all relevant documents must be enclosed with the letter and should be sent to the Ombudsman center.

Step 5 – You will be required to fill in P-II and P-III forms (These are simple forms used for taking down the complaint details in a particular format). You can also fill the forms and send them by post to the Insurance Ombudsman and they will reach back to you shortly.

Step 6 – Once you register the complaint and submit all the appropriate documents, you will be given a date where you and a representative of the respective insurance company will be called for a hearing.

An executive will be assigned by the Insurance Ombudsman to represent you free of charge. Usually, the matter will be solved within just one hearing as there is no system of providing further dates.

What is the time limit for approaching the Insurance Ombudsman?

You will have to register your complaint with the Ombudsman within one year of your claim rejection by the insurance company.

Process of judgment

During the hearing, the Insurance Ombudsman will pay detailed attention to what the policyholder and the insurance company have to say. The Ombudsman will decide on a fair conclusion. It will pass an unprejudiced judgment and the minutes will be prepared.
If the policyholder accepts the Ombudsman’s judgment as full and final, it will intimate the insurance company and the company must comply with the terms of the settlement within 15 days.

However, If the policyholder does not accept the terms of the settlement the Insurance Ombudsman will pass an award within 90 days after receiving all the requirements from the complainant. This will be binding on the insurance company.
The insurance company cannot challenge this settlement decision further and is bound to comply with the terms of settlement within 30 days of award receipt.

However, if the policyholder is not satisfied with the terms of the settlement he is free to go to court and challenge the order passed.

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