“With an objective of providing a forum for resolving disputes and complaints from the aggrieved insured public or their legal heirs, nominee or assignee against Insurance Companies, the Government of India, in exercise of powers conferred by section 24 of the Insurance Regulatory and Development Authority Act, 1999(41 of 1999) framed "Insurance Ombudsman Rules, 2017", which came into force w.e.f. 25th April, 2017. These Rules aim at resolving complaints relating to the settlement of disputes with Insurance Companies and their agents and intermediaries on personal lines of insurance, group insurance policies, policies issued to sole proprietorship and micro enterprises in a cost effective, efficient and impartial manner. These Rules apply to all the Insurance Companies operating in General Insurance business and Life Insurance business, in Public and Private Sector.
To implement the above Rules, the Institution of Insurance Ombudsman has been established and is functioning since 1999. The Ombudsman functions within a set geographical jurisdiction and can entertain disputes relating to:
(a) Delay in settlement of claims.
(b) Any partial or total repudiation of claims by an insurer.
(c) Any dispute over premium paid or payable in terms of the policy.
(d) Misrepresentation of policy terms and conditions at any time in the policy document or policy contract
(e) Any dispute on the legal construction of the policies in so far as such disputes relate to claims.
(f) Policy servicing related grievances against insurers and their agents and intermediaries
(g) Issuance of life insurance policy, general insurance policy including health insurance policy which is not in conformity with the proposal form submitted by the proposer.
(h) Non-issue of any insurance policy to customers after receipt of premium in life insurance and general insurance including health insurance.
(i) Any other matter resulting from the violation of provisions of the Insurance Act, 1938 or the regulations, circulars, guidelines or instructions issued by the IRDAI from time to time or the terms and conditions of the policy contract, in so far as they relate to issues mentioned at clauses(a) to (f).”
To know more about the institution of the Ombudsman, please visit: http://ecoi.co.in/faqs.html