The Executive Council of Insurers (ECOI) has been established under Insurance Ombudsman Rules 2017, to set-up and facilitate the Institution of Insurance Ombudsman in India.
The Executive Council of Insurers consists of two representatives nominated by the Life Insurance Council, two representatives from General insurers, other than stand-alone health insurers and one representative representing stand-alone health insurers nominated by the General Insurance Council, one representative of the IRDAI and one representative of the Central Government in the Ministry of Finance from the Department of Financial Services not below the rank of Director; and the Chairman, Life Insurance Corporation of India(LIC of India) established under the Life Insurance Corporation Act, 1956( 31 of 1956) or the Chairman, General Insurers’(Public Sector) Association of India (GIPSA) established under the General Insurance Business(Nationalisation) Act, 1972(57 of 1972) provided they are not acting as Chairperson of the Executive Council of Insurers.
The Insurance Ombudsman Rules, 2017 (IO Rules - 2017) contain provisions in respect of appointment and office term, etc for Insurance Ombudsman and also include stipulations in respect of staffing and administration of Ombudsman Centre, powers of Ombudsman, manner of lodging complaint and disposal of complaint by Ombudsman either by way of Recommendation or Award. Miscellaneous Provisions of the notification relate to constitution of Advisory Committee, submission of annual report, etc.Insurance Ombudsmen are appointed by the Executive Council of Insurers and are empowered to entertain complaints against insurance companies and their agents and intermediaries on the following aspects in respect of personal line insurances, group insurance policies, policies issued to sole proprietorship and micro enterprises:
(a) Delay in settlement of claims.
(b) Any partial or total repudiation of claims by an insurer.
(c) Any dispute over premium paid or payable in terms of the 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 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)
• 17 Ombudsman Centres, covering the country, established in Ahmedabad, Bengaluru, Bhopal, Bhubaneswar, Chandigarh, Chennai, Delhi, Guwahati, Hyderabad, Jaipur, Kochi, Kolkata, Lucknow, Mumbai, Pune, Patna and Noida.
• In the last sixteen years i.e. 01.04.2000 to 31.03.2017, the institution has dealt with 2,93,442 complaints and has given relief to aggrieved claimants.
• Procedure is quick and free of cost.
• Apart from regular hearings at the Centres, Insurance Ombudsmen hold outstation hearings within their territorial jurisdiction for the convenience of complainants.
• With a current complaint disposal rate of 92.32% as on 31.03.2017 the institution has given a good account of itself as an alternate Grievance Redressal Machinery in Insurance Sector.