1)How to lodge online complaint with Insurance Ombudsman.
Visit our website www.cioins.co.inand click on ”Register” under the heading” Lodge & Track Complaint Online “on Home page of our website All the mandatory fields are to be filled in & mandatory documents are to be uploaded. After clicking “ Register” button, an OTP will be sent from email id firstname.lastname@example.org to complainant on his mail id. On entering the OTP an Online complaint no is generated.
2)What are the Mandatory Documents for lodging complaint through ONLINE platform. (Please upload files upto 10 MB in size).
1.Letter/email from Insurer/insurer broker rejecting the representation/repudiating the claim
2.KYC particulars,Aadhar card, Pan Card,Driving License, etc:
3.Copy of Insurance Policy
3)Who can lodge the complaint with Insurance Ombudsman.
If you have an Insurance Policy on personal lines, group insurance policies, policies issued to sole proprietorship & micro enterprises and have a grievance against an insurer( including its agents and intermediaries) or an insurance broker, complaint can be filed by Policyholder or claimant/legal heirs, nominee or assignee against any Insurer both in Public Sector and Private Sector, pertaining to life insurance, general insurance and health insurance policies. 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.
4)When to lodge a complaint with ombudsman
Complaint is to be lodged with Insurance Ombudsman as per the territorial jurisdiction, within one year of:
1) the rejection by the insurer /insurer broker ,of the representation of the complainant or
2) the complainant is not satisfied with the reply given to him by the insurer/insurer broker
3) after expiry of one month from the date of sending written representation or through electronic mail to the insurer /insurer broker and the insurer/insurer broker fails to furnish the reply.
5)How is the territorial jurisdiction of Insurance Ombudsman to be applied to complaints?
The complaint will lie with the Insurance Ombudsman under whose territorial jurisdiction the Branch or Office of the Insurer complained against or the residential address or place of residence of the complainant is located. Insurance Ombudsman operates only within the territorial limits specified under” Offices of Ombudsman” on our website.
6)What complaints are entertained by Insurance Ombudsman.
The Ombudsman may receive and consider complaints or disputes alleging deficiency in performance required of an insurer (including its agents and intermediaries) or an insurance broker on any of the following:
a)Delay in settlement of claims beyond the time specified in the regulations frame under IRDAI Act 1999..
b)Any partial or total repudiation of claims by an insurer.
c)Any dispute over premium paid or payable in terms of the insurance policy.
d)Misrepresentation of policy terms and conditions at any time in the policy document or policy contract.
e)Any dispute on the legal construction of the policies in so far as such disputes relate to claims.
f)Policy servicing related grievances against insurers and their agents and intermediaries
g)Issuance of life insurance policy, general insurance policy including health insurance policy which is not in conformity with the proposal form submitted by the proposer.
h)Non-issue of any insurance policy to customers after receipt of premium in life insurance and general insurance including health insurance.
i)Any other matter arising from non-observance of or non-adherence to the provision of any regulations made by the IRDAI with regard to protection of policyholders’ interest or otherwise, or of any circular, guideline or instruction issued by IRDAI, or of the terms and conditions of the policy contract, in so far as such matter relates to issues referred to in clauses(a) to (h)
7)What is maximum limit of compensation awarded by the Insurance Ombudsman
The maximum limit of compensation awarded by Insurance Ombudsman shall not be exceeding 30 lakhs.
8)How to track the Status of Complaint registered through Online Platform
Complainant can track the status of his complaint by clicking “Track “button provided under the heading “Lodge & Track Complaint Online” on Home page of our website www.cioins.co.in
Complaint can be tracked by the complainant by giving either of the inputs viz Online complaint no., Mobile No. or Email id.