General FAQs

Our Response : The complaint may be lodged with the office of Insurance Ombudsman under whose territorial jurisdiction
(a) the Branch or Office of the insurance company or the insurance broker falls; OR
(b) the residential address or place of residence of the complainant falls.
Our Response : The details of territorial jurisdiction of the 17 offices of Insurance Ombudsman is available on our website under the heading "Offices of Ombudsman" under the section "About Us" 
Our Response : Any person who has a grievance against an insurance company (or insurance broker, as the case may be) may himself or through his legal heirs, nominee or assignee, make a complaint in writing to the Insurance Ombudsman within the defined territorial jurisdiction as mentioned above.
Our Response : The office of Insurance Ombudsman is mandated to resolve all complaints pertaining to policies issued on personal lines of insurance, group insurance policies, policies issued to sole proprietorship and micro enterprises.
Insurance Ombudsman can entertain complaints alleging deficiency in performance required against Insurance companies (including its agents and intermediaries) on the following grounds:
(a) delay in settlement of claims, beyond the time specified in the regulations, framed under the Insurance Regulatory and Development Authority of India Act, 1999;
(b) any partial or total repudiation of claims by the life insurer, general insurer or the health insurer;
(c) disputes over premium paid or payable in terms of insurance policy;
(d) misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
(e) legal construction of insurance policies in so far as the dispute relates to claim;
(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-issuance of insurance policy after receipt of premium in life insurance and general insurance including health insurance; and
(i) any other matter arising from non-observance of or non-adherence to the provisions of any regulations made by the Authority with regard to protection of policyholders' interests or otherwise, or of any circular, guideline or instruction issued by the Authority, or of the terms and conditions of the policy contract, insofar as such matter relates to issues referred to in clauses (a) to (h).
Our Response : As per Notification dated 1st June ,2020, S.O. 1702(E), issued by Ministry of Micro, Small and Medium Enterprises, "Micro enterprise" means an enterprise where the investment in plant and machinery or equipment does not exceed one crore rupees and turnover does not exceed five crore rupees.
Our Response : The complaint can be made by the insured himself or by his legal heirs, nominee or assignee either through a written complaint duly signed by him or through electronic mail or online through the online platform developed by the Council of Insurance Ombudsmen through the website www.cioins.co.in . For address of Office of Insurance Ombudsman, kindly refer to "Offices of Ombudsman"  under "About Us"  section on the webpage. Complaint can be registered online by clicking on the "Register complaint" under the Section "Complaint Online" on the webpage.
Our Response : The following documents are required
a) Copy of representation submitted to Insurance Company/ Insurance Broker
b) KYC particulars: Aadhar card, Pan Card, Driving License, etc
c) Photograph (in case of online registration of complaints)
d) Letter from Insurance Company/ Insurance Broker rejecting the representation / repudiating the claim.
e) Copy of Insurance Policy
f) Any other document(s).
Our Response : Complaint can lodged with the Office of the Insurance Ombudsman within one year from
a) date of rejection of the complaint by the Insurance Company/Insurance Broker
OR
(b) expiry of one month of filing the complaint if the Insurer fails to reply
However no complaint can be entertainable on the same subject matter on which proceedings are pending before or disposed of by any court or consumer forum or arbitrator.
Our Response : The Insurance Ombudsman can entertain complaints where the quantum of loss payable under the insurance policy does not exceed rupees 50 Lakhs.
Our Response : 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.
Our Response : Before you submit your Grievance to Insurance Ombudsman please ensure that:
• You should have made a complaint to Insurance Company/Insurance Broker
• Insurance Company/Insurance Broker should have failed to furnish reply to you after the expiry of one month of your complaint;
OR
You are not satisfied with the response given by Insurance Company/Insurance Broker
• The complaint is being made to the Insurance Ombudsman within one year from:
(a) Date of rejection of the complaint by the Insurance Company/Insurance Broker
(b) Expiry of one month of filing the complaint if the Insurer/Broker fails to reply
• The amount of Compensation sought in Insurance Ombudsman should not exceed Rs. 50 Lakhs.
Our Response : As per the Insurance Ombudsman Rules 2017, there is no provision to engage a lawyer.
Our Response : In case both parties agree for mediation, the Insurance Ombudsman shall give his Recommendation within 1 month of date of receipt of mutual written consent for such mediation, otherwise, he shall pass his Award within 3 months of the receipt of all requirements from the complainant.
Our Response : The Insurance Ombudsman cannot award ex-gratia payment.
Our Response : No charges are required to be paid for lodging a complaint with the Insurance Ombudsman.
Our Response : Wherever considered necessary, the Insurance Ombudsman will conduct hearing of both the parties either in person or through video conferencing. The Ombudsman may, on his own or on the request of the complainant, hear a matter through video-conference if he is satisfied that circumstances so require, after notifying the complainant and the insurer or insurance broker concerned.
Our Response : Hearings may be conducted outside the Office of Insurance Ombudsman but within the territorial jurisdiction of that centre, wherever warranted.
Our Response : Complaints can be lodged against any insurer (including their agents and intermediaries) - public sector and private sector for complaints pertaining to life, health and non-life segment.
Our Response : Yes, complaints can be lodged against Insurance Brokers.
Our Response : Only individual policyholders, sole proprietorship or micro enterprises who have taken insurance on personal lines are eligible. However, a member covered under a Master Policy or a Group Insurance (or if deceased, the legal heir /nominee) can approach the Ombudsman, provided the payment of the claim under such policy is to be made to the individual, as beneficiary.
Our Response : The award of Insurance Ombudsman shall be binding on the insurers (or insurance broker, as the case may be). However, if the complainant is not satisfied with the decision of the Insurance Ombudsman, he/she may exercise the right to take recourse to the normal process of law against the Insurance Company/Insurance Broker.
Our Response : Such types of complaints does not fall within the scope of the Insurance Ombudsman, 2017 and hence are non-entertainable.
Our Response : The Offices of the Insurance Ombudsman are established to directly deal with complaint. Therefore, copies of complaints or queries and correspondence need not be forwarded to the Office of the Council for Insurance Ombudsmen.
Our Response : Yes
Our Response : Where a complaint is settled through mediation, the Ombudsman shall make a recommendation which it thinks fair in the circumstances of the case, within one month of the date of receipt of mutual written consent for such mediation and the copies of the recommendation shall be sent to the complainant and the insurer [or insurance broker, as the case may be,] concerned. Where the complaint is not settled by way of mediation, the Insurance Ombudsman shall pass an award within a period of three months of the receipt of all requirements from the complainant.
Our Response : For any information or queries you may either write to us on address - Council for Insurance Ombudsmen, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400054 or email us on inscoun@cioins.co.in

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