The basic purpose of a term insurance plan is to provide financial security to your family in case of your unfortunate demise during the policy tenure. When you buy term insurance, you place your faith in the insurance company to stand by your family when you are not around. When you or your nominee claims the term policy death benefit, you want to be sure that the insurance company follows the right protocols of claim settlement and addresses all your grievances. The claim process should be smooth and hassle-free.

For this purpose, the Government of India created the Insurance Ombudsman in India scheme for all policyholders, enabling them to settle their insurance complaints out of the court system. Ideally one should approach the grievance redressal team to settle their case. If the case remains unresolved, then the insurance Ombudsman will aim to provide a cost-effective, efficient, and impartial way to resolve insurance-related conflicts.

Here is everything you need to know about the Insurance Ombudsman:

 

Who is an Ombudsman in Insurance?

The institution of Ombudsman Insurance in India was established by the Government of India in November 1998. The primary objective of the institution is to fasten and systematise the process of grievance settlement of insurance policyholders. The Ombudsman aims to mitigate all issues encountered in settlement of these claims. The basic purpose of the formation of an Ombudsman in Insurance is to provide an effective, efficient and unbiased settlement of policyholder’s complaints.

As per the latest report, there are 17 Insurance Ombudsman in India. These are located in:

 

1. Mumbai

2. Pune

3. Delhi

4. Bangalore

5. Ahmedabad

6. Bhopal

7. Chandigarh

8. Bhubaneswar

9. Chennai

10. Guwahati

11. Jaipur

12. Hyderabad

13. Kolkata

14. Kochi

15. Lucknow

16. Noida

17. Patna

When can You Approach the Insurance Ombudsman in India?

You can approach the Ombudsman with your insurance complaint, if:

 

• You have first registered the same complaint with your insurance company, and the company has either rejected the complaint, not responded to it for 30 days or has not resolved it to your satisfaction.

• Your complaint pertains to your life insurance policy

• The value of your life insurance complaint is not more than Rs 30 Lakh.

The complaint you make in such cases should be in writing as per the Insurance Ombudsman complaint format. You can visit the Ombudsman office to make the complaint or send it through the post, fax or email. However, you will need to submit a hard copy in case you file the complaint via email. Further, you must file the insurance complaint within one year of the complaint rejection by the insurer. Also, the same complaint should not be pending before a court or consumer forum.

Who can File a Complaint with the Insurance Ombudsman in India?

Anyone with a grievance related to their insurance plan in India can file a complaint with the Insurance Ombudsman through themselves or their legal heirs or assignees/nominees.

List of Concerns You can Raise with the Insurance Ombudsman in India

Your complaint to the Insurance Ombudsman in India can be about any of the following concerns:

 

• Delay in claim settlement of your term insurance or any other insurance policy beyond the period specified by the IRDAI (Insurance and Regulatory Development Authority of India), 1999.

• Any partial or total rejection of the term policy claim by the insurance company.

• Any dispute or disagreement on the premiums paid or payable

• Any discrepancy or misrepresentation in the term and conditions of the insurance contract or policy documents

• Any complaints relating to the servicing of grievances

• Issue of a policy, which is different from the one opted by the policyholder

• Non-issuance of insurance even after payment of premiums

• Any other matter that causes a violation of the terms and specifications of the Insurance Act, 1938. For example, denial of term insurance tax benefits* by the insurance company.

How to file a complaint with the Insurance Ombudsman?

If you do not get any response or are not satisfied with the insurance company’s response to your complaint, you can follow these simple steps to file your complaint with the Insurance Ombudsman in India:

 

• Contact the Insurance Ombudsman office in your jurisdiction. For instance, if you are a resident of Delhi, you can approach the Insurance Ombudsman office in Delhi to file the complaint. The geographical location of your insurance company does not matter. The company could be based anywhere in India.

• You can file the complaint in the Insurance Ombudsman complaint format and send a hard copy to the Insurance Ombudsman. You can also send your complaint by email or fax.

• The complaint must include all details regarding your policy. These include policy issue information, premiums paid, pending premiums, the complaint in detail, the steps taken by the insurance company, etc. You will need to send some documents to the Insurance Ombudsman office in your jurisdiction.

• Once your complaint is registered, the Insurance Ombudsman will need you to fill in Form P-II and P-III. If you file your complaint via post, the Insurance Ombudsman will ask you to fill these forms.

• After these formalities, the Ombudsman will issue a date for hearing.

What is the settlement process followed by Insurance Ombudsman in India?

The Ombudsman acts as a mediator between you and the insurance company, enabling both parties to arrive at a fair solution. The Ombudsman gives a justified recommendation as per the facts of the case. If you agree with the settlement, the insurance company will need to comply with the terms in 15 days.

However, if the settlement does not work, the Ombudsman will pass an award within three months, which will be binding on the insurer. The insurance company will need to comply with the award within 30 days.

 

Conclusion

If you do not want to get caught in this complaint redressal process, ensure you select a reliable term insurance plan such as Tata AIA term insurance.

Tata AIA Life has been a trusted brand for millions of consumers and has honoured 99.06% of all the insurance claims filed in FY-19-20. We offer different term plans with unique benefits and comprehensive insurance coverage up to the age of 100. You have the flexibility to choose your sum assured and premium payment mode and frequency. You also get exclusive customer assistance, speedy grievance redressal and easy claim settlement.

Be wise and make the right choice! For more details, you can get in touch with our insurance advisors today!

L&C/Advt/2021/Jun/0972