Insurance Ombudsman

Prepared By: Biswajit Chakraborty Roll No. – 08fc017 IMIS, Bhubaneswar

Introduction  A quasi – judicial authority.

 A national service which assists in resolving disputes

between insured and insurers.

 Currently 12 OMBUDSMAN offices in the country.

Features  Complaints upto Rs.20 lakhs can be filed with the

OMBUDSMAN.

 Scheme for only individual beneficiaries and not corporate

entities.

 The case should not be pending before any other forum

Filing a complaint  Should be written

 Should be filed within a year of rejection by insurer

 First claims should be taken to internal grievance system of

the insurer company.

 Should be filed against the OMBUDSMAN who has

jurisdiction over the region

Characteristics of IOS  Resolves disputes between consumers and participating

companies

 Free service

 Decisions by IOS are only binding to participating companies

and not consumers.

Powers of OMBUDSMAN Empowered to consider following complaints:  Partial/Total repudiation of claim by insurer  Dispute with regard to premium paid or payable in terms of

policy  Delay in settlement of claims  Non – issuance of any insurance documents to customers

after receipt of premium

Appointment of OMBUDSMAN  Govt. bodies of insurance council issue order of appoinment

.  Recommended by chairman IRDA, chairman LIC, chairman

GIC, representative of central govt.  OMBUDSMAN are drawn from Insurance industry, civil

services, judicial services.  Appointed for 3 yrs or till the incumbant attains 65 yrs,

whichever is earlier.  No re-appointment .

End