The Insurance Ombudsman system is created by Government of India for individual policy holders, to resolve and settle their complaints against the Insurance Companies in an efficient, impartial and most importantly in a cost – effective manner. An ombudsman is usually known as a public advocate. Especially with Insurance companies which have a butter talk when issuing an insurance, and turn to be knife when a claim is filed, an ombudsman is like a lifeline in such scenario, only promising that “dharma” is on our side. Interestingly an ombudsman has some special privileges which are pro to an individual policy holder.
Usually, an ombudsman plays a key role in case of Vehicle Claim Settlement. It’s been a common practice with the public, who are always finding ways to cheat the insurer to claim for an accident, which either involved unlawful driving or not following safety precautions. While the insurer at the other end tries to find loop holes to reject a claim even if the incident and a claim is genuine in nature, the ombudsman would be the middle person to resolve the claims.
During appeal to the ombudsman, one can provide all the documents to prove his / her claim as legitimate, thereby getting orders for their claim approval. Any order passed by the ombudsman, cannot be challenged by the insurer, and the insurer has to award the order passed within 15 days. If the price of a vehicle exceeds INR 20 Lakhs, the ombudsman cannot take up the appeal as it restricted by law, and the appeal has to be made in the district court.
An appeal can be made at Ombudsman disposal only if the following conditions:
- Insurance company might not have resolved the case
- The Insurance company might have not resolved upto the consumer satisfaction
- The Insurance Company has been un–responsive for a period over 30 days.
- Claims below for vehicles costing less than INR 20 Lakhs.
- The Case shouldn’t be in the court or a court shouldn’t have issued an order.
For any vehicle claims below INR 20 Lakhs, complaints involving the following are accepted from an ombudsman:
- Partial or total rejection of a claim by Insurer
- In the case of Insurer failing to issue insurance paper despite of payments made towards the policy taken.
- If disputes arise at the legal construction of policies listed as far as it relates to claims.
- Delay in settlement of claims by the Insurer
- Disputes in premium paid or payable in terms of the insured policy.
The ombudsman would act as a mediator and a counsellor, and ensures a settlement by recommendation which works out in most cases. If recommendation doesn’t work, he passes an award which has to be strictly followed by the insurer.
Another advantage in case of an appeal at Ombudsman is that, any case filed will be disposed of within 3 months, thereby ensuring quick resolving of cases, much unlike the Indian Judiciary Court system.
Disclaimer : The above article is for information purpose only. We have provided the information with the known facts at the time of publishing. Please visit the IRDA website for updated terms and conditions for this matter.