PROCEDURE TO LODGE A 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 and their agents and intermediaries complaint can be filed by Policyholder or claimant/legal heirs, nominee or assignee.
- Please write to the Insurer.
- The insurer should deal with your complaint within 30 days.
- If you are unhappy with the solution or if there is no response to your complaint from the insurer for 30 days, then you can approach the Office of Insurance Ombudsman as per jurisdiction for value of the claim including expenses not exceeding 30 lakhs, within 1 year from date of rejection/repudiation/partial settlement of claim by the Insurer. For jurisdiction please Click here.
- You should not have approached any other forum/court/arbitrator on the same subject matter of your claim.
- The forum of Insurance Ombudsman does not charge any fees for filing the complaint
The Ombudsman may receive and consider complaints relating to the following:
- Delay in settlement of claims.
- Any partial or total repudiation of claims by an insurer.
- Any dispute over premium paid or payable in terms of the policy.
- Misrepresentation of policy terms and conditions at any time in the policy document or policy contract.
- Any dispute on the legal construction of the policies in so far as such disputes relate to claims.
- Policy servicing related grievances against insurers and their agents and intermediaries
- 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.
- Non-issue of any insurance policy to customers after receipt of premium in life insurance and general insurance including health insurance.
- Any other matter resulting from the violation of provisions of the Insurance Act, 1938 or the regulations, circulars, guidelines or instructions issued by the IRDAI from time to time or the terms and conditions of the policy contract, in so far as they relate to issues mentioned at clauses(a) to (f)
The complaint shall be in writing duly signed by the policyholder or claimant/ legal heirs/ assignee/nominee. Click here to download Complaint form.
Send the Complaint letter alongwith the photocopies of the supporting documents as given hereunder to the Office of Insurance Ombudsman.
- Policy copy ( all pages of policy under which complaint is lodged)
- Copies of all old policies for covering of Insurance since last 48 months prior to this policy if claim is rejected on grounds of pre-existing diseases/waiting period.
- Repudiation/Denial letter/Partial settlement letter issued by the Insurer.
- Representation letter sent to the Insurer.
- Any other correspondence exchanged with Insurer & TPA.