Articles 1735 views March 20, 2020

Ombudsman Scheme in Insurance

The ombudsman scheme in insurance is an important scheme that every person should be aware of. An ombudsman is an authority appointed by the IRDA. There are 17 insurance ombudsmen spread out all across the country. The duty of an ombudsman primarily includes solving disputes between the policyholders and the insurance companies. This is a very important and useful scheme to know and use whenever there is a dispute.

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When can the Ombudsman Scheme in insurance be used?

You can use the ombudsman scheme in insurance to address any of the following issues:

  1. When the insurance company does not address your complaint, or they take too long to address it.
  2. When the solution offered by the insurer is not satisfactory.
  3. When there is no response from the insurance provider for over a month.

The insurance ombudsman can only resolve issues that an individual raises for problems faced by him/her related to his/her own policy and not any group insurance policy. The concerns may be related to a life insurance plan or a general insurance plan.

What kind of problems can you file with the ombudsman?

You can make use of the ombudsman scheme in insurance when you have the following problems to resolve:

  1. When the insurance company takes too long to settle your claim.
  2. When health insurance, life insurance or any other general insurance claims are rejected unfairly by the insurance company.
  3. When there is a dispute regarding the payment of premiums towards an insurance policy.
  4. When the insurance provider offers false promises and misrepresentations in the policy documents.
  5. When there is a complaint about the service provided by the insurer or its agents.
  6. When a policy is incorrectly issued, without considering the requirements mentioned by the proposer in the application form.
  7. When the insurer receives the premium but does not issue the insurance policy.
  8. If there is any breach of contract or if the insurance company does not follow the rules set by the IRDA.

Feel free to contact an insurance ombudsman if you face any of these issues.

Resolving the matter

Working as a mediator between you, the policyholder, and the insurance company the ombudsman assess both sides of the story and then passes a judgement. If the insurance company is indeed found to be engaging in foul play, it is served a notice and asked to pay the policyholder what is due. If, after completing the case study, the ombudsman finds the insurance company to be fair and within the rules, the policyholder is informed and the case is closed.

All matters are settled within three months of the complaint being filed. If a ruling is passed against an insurer, the company has to comply with it within 30 days.

In conclusion

The IRDA is the insurance regulatory body in India. It works very sincerely to ensure the insurance companies do not cheat their clients and that all the policyholders in India get the correct and best value out of their insurance covers. The ombudsman scheme in insurance goes a long way to assure this happens.

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