Ashok had a problem with his Life Insurance as multiple policies were sold to him whereas he asked for one policy only. After along correspondence with Insurer, they refused to comply and sent a refusal letter. Within 30 days, Ashok prepared a small note in Hindi and represented the case to local insurance ombudsman. Within 60 days, Ombudsman called both parties and awarded order in favour of Ashok.
Ravi was having a medical insurance with a reputed Health Insurance company. Ravi was hospitalised but Insurer paid only 50% bills refusing to pay balance on account of room rent. Once again case of Ravi was settled at Ombudsman.
Whether you have life, health or General Insurance, you can approach local ombudsman for the resolution of your complaint. You do not need any lawyer or mediator to reach ombudsman. In 2000, Insurance sector was opened to Private Sector under regulations of IRDA. IRDA formed a body for grievance redressal. An Institution of Insurance Ombudsman was formed with basic objective of redressal of grievances of Policy Holders of all three i.e Life, Health and General Insurance. Ombudsman work under Insurance Council and have multiple centres covering almost all top cities in India. Each ombudsman office has a territorial jurisdiction.
Types of complaint represented to the Insurance Ombudsman
- Claim repudiation delay in claim settlement
- Partial claim settlement
- Any dispute related to policy terms and conditions
- Complaint of fraud and mis-selling
- Policy servicing issues
- Complaint against intermediaries.
Who can make a Complaint?
- Any insured person or legal heirs can make a complaint in writing to the ombudsman within whose jurisdiction office of insurer is located.
- Complainant need to visit Ombudsman office directly or can send registered letter or mail. Complainant can not take help of any mediator.
- Firms can also approach ombudsman through an authorized representative.
How a complaint can be made?
- After receiving a denial letter from Insurer or after 30 days of sending a written complaint to insurer.
- Complaint can be made in writing.
- Complaint need to make within one year of denial from Insurer.
- If any proceedings are going on with Consumer Court than Ombudsman cannot be approached.
- Ombudsman do not charge any fees.
Insurance Ombudsman Awards
- Mediation – Insured and Insurer can seek mediation.
- After representation by both parties, Ombudsman award decision which is binding on Insurer however Insured can still approach consumer court or take other legal recourse. Insurer has to comply award within 15 days.
- Mostly Ombudsman has to award decision within 90 days.
Insurance Samadhan is a grievance redressal platform which guide aggrieved public with all platforms and help in preparing facts in technical language which can be easily understood by Ombudsman.
At InsuranceSamadhan.com, we have helped resolve over 12,600 customer grievance cases in the past related to Life Insurance, Health Insurance, General Insurance and other financial products.
You can also
Visit our website: insurancesamadhan.com
Call us on +91 9513631312
WhatsApp: 9910998252
Mail us at corporate@insurancesamadhan.com
Click here to register your case with us
No proper support By Star health insurance
No professional support
Application amount didn’t return
Is there a forum for Hospitals Empaneled with TPA’s and Insurer to address issues/complaints on cashless services rendered to beneficiaries. I have issues with TPA’s who do not respond to mails.
Yes. Wrongful denial of cashless facility by PPN Hospital is a breach of contract and deficiency in service. Alongwith shortsettlement complaint, this issue can also possibly be categorically raised before Ombudsman for relief and interest..
I had taken policy from Bajaj finserve….the payment was credited and acknowledged but policy is not being issued as yet…pks expedite the ssme
Hi Vinay,
Please register your insurance complaint with us by clicking the link below.
https://www.insurancesamadhan.com/register?utm_source=organic&utm_medium=blog&utm_campaign=blog_post&utm_term=blog_term
chola mandalm health insurance is not renewing my health insurnace policy without assigning any reason
Hi, our team will contact you regarding you issue just fill the form by clicking the below link.
http://bit.ly/3EtbXJ9
Thanks
not got full refund even if i cancelled policy within free look period in care health insurance
Hello,
Please send us your details at corporate@insurancesamadhan.com, so that one of our representatives can discuss your concerns in more detail.
Medi Assist TPA is providing worst service taking so much time to approve claims, repudiate claims and denial claims.
Please send us your details at corporate@insurancesamadhan.com, so that one of our representatives can discuss your concerns in more detail.
No proper response and settlement of claim for more than 3 months ( Bharthi AXA insurance merged with ICICI Lombard)
We understand your situation, can you please send us your details at corporate@insurancesamadhan.com, so that one of our representatives can discuss your concerns in more detail.
My parents have held a health insurance policy since 2007 from ICICI Lombard of Rs 2 lakh each. The policy came with reset benefit. However in 2021 policy document the company removed reset benefit for SI of less than Rs 2 lakh. No prior information was provided. When we complained in 2023 policy year they removed the SI slab of Rs 2 lakh and moved us to Rs 3 lakh slab. By doing so the premium increased 66 percent, from Rs 42k to 70k. For my dad who is 80 plus it increased 75 percent to Rs 1 lakh pa. We asked the insurer to retain the same SI but the company said that Rs 2 lakh slab doesn’t exist anymore so it’s not possible. My parents can’t afford such high premium and will have to opt out of their policies. They can’t even port as my mom is a cancer survivor and sad has a weak heart. Does regulations allow insurers to do such things unilaterally without customer consent?
Dear Sir,
We truly understand your issue and the problem of heavy increase in the premiums specially post COVID.
Also, it is an open market, and all the insureds can Port their policies to move to an affordable plan. But as you pointed out that due to higher age and previous health issues, porting is not an option and is not recommended.
Regulators have ensured that the insurers must have similar pricing for all and cannot be biased when charging the same type of insureds. In this case as the insurer has discontinued the slab for all, we are left with no option but to pay as per their sum insured and premium slabs.
If unsatisfied, you may reach out to the grievance cell of IRDA raising your concerns.