The Insurance Ombudsman scheme was created by the central government for individual policyholders to settle cases outside of courts in an effective, efficient and impartial way.
There are at present 17 Insurance Ombudsman in different locations and any person who has a grievance against an insurer may make a complaint to the ombudsman.
All the offices of the Insurance Ombudsmen put together disposed of 40,527 complaints during 2021-22. Of those, the Delhi Centre disposed 3,830 complaints, which is 9.4 per cent of the all-India figure.
For large-scale awareness, the office of the Insurance Ombudsman, Delhi, convened a conference on Friday to explain the measures the ombudsmen offices take to facilitate the general public in the resolution of grievances against insurance companies.
At the conference, the Ombudsman office gave a briefing on how to approach the Ombudsman office and the common checkpoints while purchasing an insurance policy.
Following are some of the things one must note before approaching an Ombudsman office.
* You should have made a complaint to the Grievance Department of the Insurance Company.
* The complaint can be made to the Insurance Ombudsman within one year from:
I. after the decision of the insurer, rejecting the representation is received; or
II. after receipt of the decision of the insurer, as the case may be, which is not to the satisfaction of the complainant; or
III. after the expiry of a period of one month from the date of sending the written representation to the insurer, if the insurer fails to furnish a reply to the complainant.
* The Ombudsman can condone the delay in submission of complaint beyond one year, on case-to-case* basis, after hearing out both the parties.
* The amount of relief sought in the complaint does not exceed Rs 30 Lakh.
* No complaint before the Insurance Ombudsman shall be maintainable on the same subject matter on which proceedings are pending before or disposed of by any court or consumer forum or arbitrator.
Precautions to be taken before and after purchasing an insurance policy:
. Do not fall prey to unrealistic returns or other benefits like interest-free loans, revival or porting of another lapsed policy, or bonus/commission.
. In the Proposal Form and during the verification calls, always provide actual answers; never be* prompted by anyone else while providing the answers.
. Do read policy documents carefully, and in case of deviated promises, approach your Insurance* Company’s office within the free-look period after receipt of the policy document.
Procedure for disposal of complaints by the Ombudsman office:
. Upon receipt of the complaint along with the supporting documents including the policy copy and copy of correspondence between the two parties, the IO Office registers a case and calls for a response from the Insurers and thereafter sets up a hearing.
. If during the hearing, both parties arrive at a settlement, which appears to the IO as fair and* reasonable for both the parties, then the settlement get converted into an award (called as ‘Recommendation’, under Rule 16).
. If during the hearing, both parties are unable to arrive at a settlement, then the hearing is* concluded and an award is made on merits (under Rule 17).
. The Merit Award is binding on the Insurance Company, inasmuch as the Company cannot agitate* the matter any further in other forums/courts.
. The Merit Award is not binding on the complainant, and the complainant has full freedom to* present his grievance to any other forum/court.
. Over 50 per cent of the complaints registered in the Delhi Centre have been resolved by way of*conciliation/settlement.
Online hearings and complaint filing:
As per the amendments introduced to the IO Rules in 2021, the hearings can be conducted online.* Now the majority of the hearings are being conducted online, as it has turned out to be convenient to all concerned. However, the complainants or insurers who face difficulty in accessing the connectivity, are facilitated by providing a terminal free of cost at the IO Office.
The amended rules have also allowed the online filing of complaints. This model has achieved some* popularity, but the majority of complainants prefer to file their complaints in physical mode. Complaints submitted in either mode get the same attention from the Ombudsman Office.
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)