The institution of insurance ombudsman was established by the Government of India in November 1998. The purpose of this institution is to fasten the systematic disposal of customers’ grievances and mitigation of issues involved in the settlement of those complaints. The institution plays an important role in protecting the interests of customers and building trust in the system.
Functions of Insurance Ombudsman
Insurance Ombudsman typically has two types of functions – Conciliation and Award Making. The institution is authorised to receive and address the complaints of the customers. Such complaints may associate to any grievance against the insurance service provider like:
- Any total or partial denial or refutation of claims by the insurance company
- Disputes related to payable or paid premiums
- Disputes related to the legal structure of the policy’s wordings
- Delay in the process of settling claims
- Not issuing insurance documents related to the policy even after receiving the premium amount
However, the powers of insurance ombudsman are restricted to the insurance contracts value not more than Rs. 20 lakh.
Insurance Ombudsman: Territorial Jurisdiction
The governing body appoints the ombudsman for the different locations across the country. The details of the areas along with contact details of present insurance ombudsman have been listed below:
|State and Jurisdiction Office Details||Jurisdiction of Offices, Union Territory and Districts||Contact Details|
Jeevan Prakash Building, 6th floor,
Tilak Marg, Relief Road,
|Gujarat, Daman and Diu and Dadra and Nagar Haveli||Tel.: 07927546139/150
Jeevan Soudha Building, PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
JP Nagar, 1stPhase,
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opposite Airtel Office,
near New Market,
|Madhya Pradesh and Chattisgarh||Tel.: 0755-2769200/201/202
62, Forest park,
SCO No. 101, 102 and 103, 2nd Floor,
Batra Building, Sector 17 – D,
|Punjab, Chandigarh, Haryana,
Jammu and Kashmir
Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet,
|Pondicherry Town and
Karaikal (part of Pondicherry) and Tamil Nadu
2/2 A, Universal Insurance Building, Asaf Ali Road,
Jeevan Nivesh, 5th Floor,
Nr. Panbazar over bridge, S.S. Road,
|Assam, Manipur, Meghalaya, Mizoram, Nagaland, Tripura and Arunachal Pradesh||Tel.: 0361-2632204/2602205
6-2-46, 1st floor, “Moin Court”,
Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool,
|Telangana, Andhra Pradesh, Some part of Pondicherry Territory and Yaman
Jeevan Nidhi – II Bldg., Ground Floor,
Bhawani Singh Marg,
2nd Floor, Pulinat Building,
Opposite Cochin Shipyard, MG Road,
|Kerala, Mahe (part of Pondicherry) and Lakshadweep||Tel.: 0484-2358759/2359338
Fax: 0484 – 2359336
Hindustan Building, Annexe, 4th Floor, 4, CR Avenue,
|Sikkim, West Bengal and Andaman and Nicobar Islands||Tel.: 033-22124339/340
Fax: 033 – 22124341
6th Floor, Jeevan Bhawan, Phase-II,Nawal Kishore Road, Hazratganj, Lucknow-226001
|Districts of Uttar Pradesh: Banda, Jhansi, Lalitpur, Chitrakoot, Hamirpur, Mirzapur, Allahabad, Fatehpur, Sonbhadra, Varanasi, Mahoba, Jaunpur, Pratapgarh, Jalaun, Gazipur, Lucknow, Kanpour, Gorakhpur, Unnao, Bahraich, Lakhimpur, Sravasti, Raebareli, Barabanki, Faizabad, Gonda, Amethi, Balrampur, Kaushambi, Basti, Ballia, Chandauli, Ambedkarnagar, Maharajganj, Sultanpur, Azamgarhm, Santkabir Nagar, Mau, Deoria and Sidharth Nagar||Tel.: 0522-2231330/331
3rd Floor, Jeevan Seva Annexe,
SV Road, Santacruz (W),
Mumbai – 400054
|Mumbai (excluding Thane and Navi Mumbai) and Goa||Tel.: 022-26106552 / 26106960
4th Floor, Main Road,
Naya Bans, Sector 15,
|Uttrakhand and the Uttar Pradesh districts: Agra, Mathura, Bareilly, Bagpat, Aligarh, Etah, Bijnor, Bulandshehar, Badaun, Kanooj, Meerut, Mainpuri, Moradabad, Farrukhabad, Muzaffarnagar, Gautambodhanagar, Etawah, Oraiyya, Ghaziabad, Shamli, Hathras, Shahjahanpur, Pilibhit, Firozbad, Sambhal, Kanshiramnagar, Saharanpur, Kashganj, Hapur, Amroha, Hardoi and Rampur||Tel.: 0120-2514250/252/253
1st Floor, Kalpana Arcade Building, Bazar Samiti Road,
|Bihar and Jharkhand||Tel.: 0612-2680952
Jeevan Darshan Building 3rdFloor, CTS No.195 to 198,
NC Kelkar Road, Narayan Peth,
|Maharashtra, Thane and Navi Mumbai
How to Lodge a Complaint to Insurance Ombudsman?
A policyholder who has any grievance against the insurance company may himself, through the assignee or nominee, or through their legal heirs can lodge the complaint in writing to their concerned insurance ombudsman which falls in their area. The complaint should be in writing and duly signed by the policy owner, nominee or assignee or the legal heirs.
The complaint should clearly state the name, address and other important details of the complainant, the address and name of the insurance company against whom the grievance is made, reasons for lodging the complaint, supported by the relevant documents, the type and amount of the loss caused and the support or help required from the concerned insurance ombudsman.
No complaint by the insured shall lie unless the customer makes the written representation to name of the insurance company. Either the service provider had rejected the request or the customer had not got any satisfactory reply from
the insurer within the specified time period (1 month) or the similar complaint should not be pending in any other court, arbitrator or consumer forum.
The concerned insurance ombudsmen are allowed to address the complaint and act wisely to provide necessary support to the customers.
When to Approach Insurance Ombudsman?
There is a time limit set by the authority to approach the insurance ombudsman. No grievance shall lie unless it is made within 12 months:
- From the date of receiving the order of the insured denying the representation
- From the date of receiving the decision letter of the insurance company which is not satisfactory to the complainant
- After one month from the date of sending the representation to the insurance service provider if they fail to give an appropriate reply to the appellant.
Q1 . Who can approach the Insurance Ombudsman?
Anyone including micro-entrepreneur, sole proprietor and members covers in any group insurance plan (any member who has any grievance against the service provider) can approach the insurance ombudsman themselves or through their assignee, nominee, legal heirs or employers.
Q2 . Is it necessary to hire a lawyer to approach the insurance ombudsman?
No, it is not necessary to hire a lawyer to approach the insurance ombudsman because formal court procedure is not involved in it.
Q3. What are the charges or fees payable for availing the services of the insurance ombudsman or lodging a complaint?
No charges or fees are needed to be paid by the complainant to file a complaint to the insurance ombudsman.
Q4. What is the time duration to dispose of a complaint by insurance ombudsman?
The standard time frame is one month if both the parties agree for mediation. Otherwise, the insurance ombudsman passes the award to give recommendations within three months from the date of receiving all the details, documents, etc. from the complainant.
Q5. Does the insurance ombudsman conduct any hearing of the parties?
Yes, if needed, the ombudsman conducts the hearing of both the parties – insurer and insured to provide them with equal opportunities of being heard before passing an award.