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Directors (Nodal Officers) of Public Grievances in GoI

Insurance Ombudsman


Yes, Insurance Ombudsman operates only within the territorial limits specified in IRDAI site under ?CONTACT US ?.

The complaint will lie with the Insurance Ombudsman under whose territorial jurisdiction the Branch or Office of the Insurer complained against is located. However, in case of Group Insurance policies, the complaint may be lodged with the Insurance Ombudsman under whose territorial jurisdiction the place of residence of the complainant falls.

Any aggrieved individual who has taken an Insurance Policy on personal lines (or if deceased, the legal heir(s) under such policy) can approach Ombudsman.

Complaints pertaining to repudiation of claims totally or partially, delay in settlement of claims, any dispute on the legal construction of the policies in so far as such disputes relate to claims, disputes regarding premiums paid / payable and non-issue of insurance documents.

The complaint is to be made in writing and may be lodged through personal approach or through post / fax / email (followed by hard copy).

Yes. Within one year of the rejection by the insurer of the?? representation of the complainant or the Insurer's final reply to the representation.

Yes. The maximum limit for the amount under dispute for which the Ombudsman can entertain a complaint is up to Rs.20 lakhs.

No. Any complainant, whose complaint on the same subject matter is or was before a Court/Consumer Forum cannot approach Ombudsman.

a. The complaint must be by an individual on a ?Personal Lines? insurance and within the terms of reference of the Insurance Ombudsman as set out under Ombudsman scheme. b. A representation should be made to the Insurance Company and either an unsatisfactory reply should have been received or the representation should stand as un-replied for at least 1 month. c. The complaint must be lodged within 1 year of the events mentioned in b. above . d. The total relief sought must be within an amount of Rs.20 lakhs. e. The subject matter of the complaint should not currently be or have earlier been before a Court/Consumer Forum.

Not necessary, as formal court procedures are not involved.

In case both parties agree for mediation, the Ombudsman shall give his Recommendation within 1 month; otherwise, he shall pass his Award within 3 months.

Yes. If the Ombudsman deems it fit in the circumstances of the case, he may award ex-gratia payment.

No fees / charges are required to be paid.

Yes, wherever considered necessary, the Ombudsman will conduct hearing of both the Parties.

Yes, hearings may be conducted outside headquarters, where warranted.

Yes, complaints can be lodged against any Insurer both in Public Sector and Private Sector in both Life and Non-Life sectors.

No, as the Recommendation or Award of the Insurance Ombudsman are both subject to acceptance by the complainant in full and final settlement of the complaint. If such acceptance is not agreeable, the complainant may exercise the right to take recourse to the normal process of law against the insurance company. Further, dismissal of a complaint by the Insurance Ombudsman does not vitiate the complainants? right to seek legal remedy against the insurers complained against, as per normal process of law.

Yes, where required, information can be sought from the Public Information Officer of the concerned Ombudsman Centre in the prescribed format, forwarded together with the requisite prescribed fee. The Appellate Authority vests with a higher ranking official from the concerned Ombudsman Centre.

If you are unhappy with your insurance company, You can approach the Grievance Redressal Officer of its branch or any other office that you deal with. You are required to submit your complaint in writing along with the necessary support documents. You should take a written acknowledgement of your complaint with the date. The insurance company should deal with your complaint within 15 days. If that does not happen or if you are unhappy with their solution you can approach the Grievance Redressal Cell of the Consumer Affairs Department of IRDA: {Having Toll Free Number 155255 (or) 1800 4254 732 or Send an e-mail to complaints@irda.gov.in. In order to make use of the Integrated Grievance Management System: Register and monitor your complaint at www.igms.irda.gov.in alternatively , you may send a letter to IRDAI with your complaint: Please fill up and send the Complaint Registration Form along with any letter or enclosures, if felt necessary, by post or courier to: The GM IRDAI. The General Manager, Consumer Affairs Department - Grievance Redressal Cell, Insurance Regulatory and Development Authority of India (IRDAI) 3-5-817/818, United India Towers, 9th Floor, Hyderguda, Basheerbagh, Hyderabad ? 500 02 For more information please visit http://www.policyholder.gov.in/Ombudsman.aspx

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The Consumer Protection Act

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