How to File a Complaint to the IRDAI Ombudsman?

IRDAI The insurance industry is growing every year but the cases of policy rejection are also increasing during the claim process. To resolve customer grievances the Insurance Regulatory Authority of India launched the offices of the Insurance Ombudsman. Many people are getting help from these offices. 

Who is the Insurance Ombudsman? 

An Insurance Ombudsman is a person appointed by IRDAI. The office of the Insurance Ombudsman is covered under the RTI Act 2005. In the country, 17 Ombudsman offices are available in different states. To file a complaint to the Ombudsman, there is no need to pay charges. The complaints where the loss payable under the insurance policy should not exceed Rs. 50 lakhs.  

Any person who wants to file a complaint against the insurance company or insurance broker can file it by himself or his legal heirs, nominees, or assignees. Complain the territorial jurisdiction of: 

• the Branch or Office of the insurance company or the insurance broker falls, or 
• the residential address or place of residence of the complainant falls. 

Documents Required to Lodge a Complaint to Insurance Ombudsman 

• Copy of representation submitted to Insurance Company/ Insurance Broker 
• KYC particulars: Aadhar card, PAN card, Driving License, etc 
• Photograph (in case of online registration of complaints) 
• Letter from the Insurance Company/ Insurance Broker rejecting the representation / repudiating the claim. 
• Copy of the Insurance Policy 
• Any other document(s). 

Note: there is no need to send copies of complaints or queries forwarded to the Office of the Council for Insurance Ombudsman. 

How Ombudsman Deal With Complaints? 

When both parties agree to mediation, the Insurance Ombudsman gives the recommendation within 1 month of the date of receipt of mutual written consent for such mediation or passes his award within 3 months of the receipt of all requirements from the complainant. 

The offices of the Ombudsman deal with the complaints of individuals only. The insurance ombudsman only deals with the complaints of individual policyholders and not Partnership Firms, Corporate Clients, Co-operative Societies, Associations, or Trusts. 

Any person who has a cover under a Master Policy or a Group Insurance (if deceased) then the legal heir or nominee can approach the Ombudsman for a claim. The individuals can lodge a complaint against any insurer (including agents and intermediaries) – public sector and private sector for complaints about life, health, and non-life segments.  

How Ombudsman Process the Complaint? 

• Visit the website CIOINS and click on ‘Register Complaint’ under the heading Complaint Online available on the Home page 
• Fill in all the relevant fields and upload the necessary documents. 
• Click on the submit button and an OTP sent to your registered mobile number.  
• Enter OTP, and an Online complaint number gets generated. 

Note: You can also send a complaint through offline mode using a) email, b) via post, and c) walk-in to the Insurance Ombudsman Office of centers, email ID, address, and jurisdiction. 

Conclusion 

To conclude, any insurance policyholder who faces an issue in the policy can reach to Insurance Ombudsman. He/she will conduct a hearing of both parties either in person or through video conferencing. After healing the matter, if the ombudsman is satisfied with the concerns, he will issue a recommendation within one month. For more information on IRDAI, insurance brokers, and insurance marketing firms, check the blogs on the RegistrationKraft.