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Insurance Ombudsman

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Insurance Ombudsman

shape Introduction

The Insurance Ombudsman is created by Government of India for individual policyholders to have their complaints settled out of the courts in an impartial, efficient and cost-effective way. There are 12 Insurance Ombudsman in different locations in India that an insured person can approach. Usually complaints are lodged with the ombudsman having jurisdiction over the location of the insurance company office that the insured person has a complaint against.

Insured persons can approach the Ombudsman with complaint if:

  • They have first approached their insurance company with the complaint and the company has not resolved it.

  • Not resolved it to the insured person’s satisfaction or Not responded to it at all for 30 days

  • An insured person’s complaint pertains to any policy you have taken in his/her capacity as an individual.

  • The value of the claim including expenses claimed is not above Rs 20 lakh.

shape Complaints

A complaint to the Ombudsman can be about:

  • Any partial or total repudiation of claims by an insurer.

  • Any dispute about premium paid or payable in terms of the policy.

  • Any dispute on the legal construction of the policies as far as it relates to claims. Delay in settlement of claims.

  • Non-issue of any insurance document to you after you pay your premium The settlement process.

  • The Ombudsman acts as counselor and mediator and arrives at a fair recommendation based on the facts of the dispute.

shape Management

Integrated Grievance Management System

  • CIRDA has launched the Integrated Grievance Management System (IGMS). Apart from creating a central repository of industry-wide insurance grievance data, IGMS is a grievance redress monitoring tool for IRDA. Policyholders who have grievances should register their complaints with the Grievance Redress Channel of the Insurance Company first. If policyholders are not able to access the insurance company directly for any reason, IGMS provides a gateway to register Complaints with insurance companies.

  • Complaints are registered with insurance companies first and only if need be, escalated them to IRDA (Consumer Affairs Department). IGMS is a comprehensive solution which not only has the ability to provide a centralized and online access to the policyholder but complete access and control to IRDA for monitoring market conduct issues of which policyholder grievances are the main indicators.

  • IGMS has the ability to classify different complaint types based on pre-defined rules. The system has the ability to assign, store and track unique complaint IDs. It also sends intimations to various stakeholders as required, within the workflow. The system has defined target Turnaround Times (TATs) and measures the actual TATs on all complaints. IGMS sets up alerts for pending tasks nearing the laid down Turnaround Time. The system automatically triggers activities at the appropriate time through rule based workflows.

  • A complaint registered through IGMS will flow to the insurer’s system as well as the IRDA repository. Updating of status will be mirrored in the IRDA system. IGMS enables generation of reports on all criteria like ageing, status, nature of complaint and any other parameter that is defined. Thus IGMS provides a standard platforms to all insurens to resolve policy holder grievances and provides IRDA with a tool to monitor the effectiveness of the grievance redress system of insurers.