How to make the most of the Insurance Ombudsman

Insurance Ombudsmen are officials, who can solve all your insurance related woes and queries in an efficient and effective manner. Here's how to make the most of this dispensation.

Through the course of your professional career, you're sure to come across officials whose help you can't do without at some point or the other. Insurance Ombudsmen may be just such officials, who can solve all your insurance related woes and queries in an efficient and effective manner.

Who are Insurance Ombudsmen?

Insurance Ombudsmen are officials whose primary duty is to handle complaints from consumers and resolve differences between insurers and consumers. They help in resolving disputes and answering queries in relation to the insurance system and therefore contribute to the confidence of all consumers in the process.

Insurance Ombudsmen usually hail from a judicial or civil services stream or from the insurance industry. An Insurance Ombudsman can hold the position for a term of three years or till he/she reaches the age of sixty-five, whichever is earlier. An Insurance Ombudsman is normally provided with the powers to make awards and conciliate between affected parties. 

What kind of problems can an Insurance Ombudsman help you with?

Some of the grounds under which you may make a complaint to an Insurance Ombudsman are:

• If the insurance company refuses to acknowledge your claim, either partially or wholly
• If the insurance company doesn't issue insurance documents after you've duly paid the premium
• If there is any delay in settling your claim on the insurer's part
• If there are any disputes regarding the wording of your insurance policy and its legal construction
• If there are any disputes regarding the premium that you've already paid or need to pay

When can I approach an Insurance Ombudsman?

You may contact an Insurance Ombudsman if you have a grievance against an insurance company, however, before consulting an Insurance Ombudsman, you should register a prior complaint with the insurer. You can then contact an Insurance Ombudsman if:

• The insurer does not respond to your complaint for a period of one month
• The insurer rejects your complaint without any valid reasons
• The insurer doesn't give a satisfactory answer to your queries
• You should also ensure that you have not filed a complaint in relation to the same matter in any court or in any other consumer forum

How can I approach an Insurance Ombudsman?

• You can contact an Insurance Ombudsman if your insurance contract does not exceed a value of Rs 20 lakh
• You should submit a written complaint and address it to the Insurance Ombudsman under whose reach the particular insurance company falls (The offices of the twelve insurance Ombudsmen are located at (1) Bhopal, (2) Bhubaneswar, (3) Cochin, (4) Guwahati, (5) Chandigarh, (6) New Delhi, (7) Chennai, (8) Kolkata, (9) Ahmedabad, (10) Lucknow, (11) Mumbai, (12) Hyderabad)
• The Insurance Ombudsman will review your complaint and take the necessary action
• Once the details have been analysed, the solution (award) will be mailed to you and the insurance company
• Insurance companies are given a time period of three months to honour the award passed by an Insurance Ombudsman
• If you're dissatisfied with the verdict given by an Insurance Ombudsman, you can file your complaint in any court or consumer forum to find a solution