OVER NOTE: INSURANCE OMBUDSM

Ashoulder to lean on when your insurer lets you down

There are 17ombudsmen across the country to listen to your grievances and sort the issue out
not more than (25 lakh or ser- Complaints can relate to have gone through the process ments from you. If not, he
KALYANI tertains only complaints where pass an award in three months.
the amount under dispute is vice providers where the invest- claim settlement delay, partial of making a written representa-
or total repudiation of claims by tion to the insurer about your If the terms of the award are ae
Its nice to have a wise and less than 00 lakh. It should ment in equipment is not more ceptable to you, it is binding on
friendly uncle who will sort out pertain to policies issued under than 00 lakh. the insurer, dispute over the grievance.
premium paid or payable, mis- the insurance company which
misunderstandings between personal lines of insurance, In both cases, the nominees, has to comply within 30 days.
you and your parents or si- group insurance policies, and legal heirs or assignees of the When to complain
representation of policy terms
and conditionsin the policy Youcan complainto the om- The recommendation or
blings! When you have a pro- policies issued to sole proprie- policyholder can also approach
blem with your insurance com- torships and micro-enterprises. the ombudsman. document or policy contract, budsmanwithin a year of the award will be based on the prin-
any dispute on the legal con- insurer either rejecting the re- ciples of natural justice and the
pany, the Insurance Any individual with compensation can be up to the
Ombudsman is such an uncle. an unresolved grie- struction of the policies in so presentation or sending his fi-
far as such disputes relate nal reply to it. In case the insur- loss you have suffered because
Itiere are 17 of them across the vance against his insu-
country; their only job is to lis- rance company can to claims, grievances relat- er fails to reply to your of the action of the insurer and
ten to your complaints and sort approach an ombud- ing to policy servicing by representation within a month cannot exceed 00 lakh, includ•
the issue out with your insu- sman. The complaint insurers and their agents of receivingit, you can ap- ing expenses.
rance firm- The advantage is can pertain to any and intermediaries, is- proach the ombudsman a However,if you don't find
that the ombudsman knows all policy purchased in suance of life, general or month after that. You cannot the award satisfactory you have
about insurance and his quasi- his individual capaci- health insurance policy take a matter that is already be- the right to take recourse to the
judicial orders are binding on ty like life, health, mo- not in conformity with fore a court or consumer forum normal legal processes by ap-
the insurance company. You, tor or property insu- the proposal form sub- to the ombudsman and there is proaching a consumer court or
however, have further rance, which are mitted by the proposer no provision for you to involve regular courts. The process has
recourse termed personal lines and non-issueof life, a lawyer in ombudsman com- been constructed in such a way
Jf you have a grievance, you ofbusiness. general or health insu- plaints and there is no fee you so as to put back some balance
should approach the Insurance Proprietors of mi- rance policy after re- have to pay anywhere in the of power in favour of the indivi-
Ombudsman of your jurisdic- croenterprises can also ceipt of premium. process. What happens after dual consumer at odds with a
tion, depending on your place approach the ombud- You have to make you make a complaint? large corporation to whom he
of residence. You can find the sman with their insu- the complaint in writ- If both you and the insurer has already paid premium, and
list of 17ombudsmen and their rance grievances. Mi- mg duly signed and with agree for mediation, the om- from whom he is expecting suc-
contact and jurisdiction details croenterprises are supporting documents. You budsman goes through the mat- cour at his time of need as pro-
on the website of the Council defined as manufae can send it by fax or email ter, conducts hearings of both mised by the insurance policy
for Insurance Ombudsman set turing units where but you need to send the parties if necessary, and makes (The writer is a business
up by the government. investment in plant hard copy too. A pre-con- a recommendation within a journalist specialising in insu-
Firstly, the ombudsman en- and machinery is •GETTY IMAGES
dition is that you should month of receiving all docu- rance and corporate history)