Skip to main content

Insurance Ombudsman - Addressing Your Complaints

 
Insurance Ombudsman - Addressing Your Complaints





Insurance policy holders often find their grievances or issues, getting a cold or unsatisfactory response from the insurer. Whether it is with reference to a mis- sold policy by a pushy agent, or a rejection in claims, many policy holders are unhappy with the support provided by the insurer. The grievances either remain unresolved or, the policy holder is left to compromise. In case of such concerns, policy holders could approach an intermediary government body known as "Ombudsman" to resolve the issue.


The Insurance Ombudsman is an authoritative body set up by the government to address policy holder's grievances that may arise in an insurance transaction. Set up in different centres across the country, the main objectives of the Ombudsman are to:


  • Receive and consider complaints of policy holders against an insurer
  • Aims to find a suitable resolution of the issue.
  • Impartial decisions and upholding right insurance practices in the sector.

Grievances Addressed By Ombudsman

 There are 12 ombudsmen in the country that would look into grievances relating to claim rejections or non-satisfactory response from the insurance company. The nature of grievances addressed is:


  • Partial or total rejection of claims by the insurance companies
  • Dispute with regards to premium payable on policy
  • Dispute on the legal construction of the policy wordings in case such dispute relates to claims
  • Delay in settlement of claims
  • Non-issuance of any insurance document

Approaching Ombudsman- How to go about it

Having understood what the Ombudsman is for, let us see the procedure required to be followed to get your complaint across.

The power vested on the Ombudsman is restricted to insurance contracts up to a value of Rs. 20 lakhs. Only if your policy contract is lower than this amount must you approach Ombudsman. Complaints should be in writing. No formal application or prescribed format exists. So a simple letter addressed Chief Vigilance Officer should do. The letter should be marked to the jurisdiction under which the office of the insurer falls. Attach copies of policy documents, any communication with the insurer along with the letter.


What you need to bear in mind

  • Before making a complaint to Ombudsman, you should have approached your insurer with the concern. Only if the issue was rejected or, a reply was not received from the insurer within a period of one month from raising the same or, if the response was unsatisfactory, must you go to Ombudsman.
  • The complaint to Ombudsman should be made within one year of the insurers reply.
  • The issue or complaint must not already be pending before any other court, arbitrator or consumer forum.

 

Response and Final Decision

It is the duty of the insurance Ombudsman to settle any complaint received, on an impartial basis. The final decision would be on the basis of what he thinks is fair and fit. Ombudsman will examine the grievance and call for a hearing of both parties. Within 30 days, he will send his recommendation on the matter to both parties. If the complainant accepts the settlement, then he has to provide a written consent within 15 days. Otherwise, insurance Ombudsman declares his decision within three months. If further dis-satisfaction persists, the policy holder would have to approach a court of law/consumer forum.


On the part of the insurance company, he must oblige with the decision passed by the insurance Ombudsman, within a span of three months.



------------------------------------------
Invest Rs 1,50,000 and Save Tax upto Rs 46,350 under Section 80C. Get Great Returns by Investing in Best Performing ELSS Funds

Top 4 Tax Saver Mutual Funds for 2017

Best 4 ELSS Mutual Funds to invest in India for 2017

1. DSP BlackRock Tax Saver Fund

2. Invesco India Tax Plan

3. Tata India Tax Savings Fund

4. BNP Paribas Long Term Equity Fund



Invest in Best Performing 2017 Tax Saver Mutual Funds Online

Invest Best Tax Saver Mutual Funds Online

Download Top Tax Saver Mutual Funds Application Forms


For further information contact Prajna Capital on 94 8300 8300

--------------------------------------------

Leave your comment with mail ID and we will answer them

OR

You can write to us at

PrajnaCapital [at] Gmail [dot] Com

OR

Call us on 94 8300 8300

---------------------------------------------

 

Popular posts from this blog

Tata Mutual Fund

Being a part of the Tata group, the fund has the backing of a very trusted brand name with strong retail connect. While the current CEO has done an excellent job in leveraging the Tata brand name to AMC's advantage, it is ironic that this was just not capitalised on at the start. Incorporated in 1995, Tata Mutual Fund remained an 'also-ran' fund house for around eight years. Till March 2003, it had a little over Rs 1,000 crore in assets and 19 AMCs were ahead of it. But soon after that the equation changed. It was the fastest growing fund house in 2004 and 2005. During these two years, it aggressively launched six equity funds, two debt funds and one MIP. The fund house as of now stands at No. 8 in terms of asset size. This fund house has a lot to offer by way of choice. And, it also has a number of well performing schemes. Tata Pure Equity, Tata Equity PE and Tata Infrastructure are all good funds. It also has quite a few good debt funds. The funds of Tata AMC are known to...
Read more

UTI Mutual Fund

Even though only a few of UTI’s funds are great performers, this public sector fund house has many advantages that its rivals do not. It has a huge base of retail equity investors and a vast distribution network. As a business, it looks stronger than ever, especially in the aftermath of credit crunch. UTI is, by a large margin, the most profitable fund company in the country. This is not surprising, since managing equity funds is more profitable than debt. Its conservative approach and stable parentage is likely to make it look more attractive to investors in times to come. UTI’s big problem is the dragging performance that many of its equity funds suffer from. In recent times, the management has made a concerted effort to improve performance. However, these moves have coincided with a disastrous phase in the stock markets and that has made it impossible to judge whether the overhaul will eventually be a success. UTI’s top performers are a few index funds, some hybrid funds and its inf...
Read more

Salary planning Article

1. The salary (basic + DA) should be low. The rest should come by way of such allowances on which the employer pays FBT and you don't pay any tax thereon. 2. Interest paid on housing loan is deductible u/s 24 up to Rs 1.5 lakh (Rs 150,000) on self-occupied property and without any limit on a commercial or rented house. 3. The repayment of housing loan from specified sources is also deductible irrespective of whether the house is self-occupied or given on rent within the overall ceiling of Rs 1 lakh of Sec. 80C. 4. Where the accommodation provided to the employee is taken on lease by the employer, the perk value is the actual amount of lease rental or 20 per cent of the salary, whichever is lower. Understandably, if the house belongs to a family member who is at a low or nil tax zone the family benefits. Yes, the maximum benefit accrues when the rent is over 20 per cent of the salary. 5. A chauffeur driven motor car provided by the employer has no perk value. True, the company would...
Read more

8 Investing Strategy

The stock market ‘meltdown’ witnessed since the start of 2005 (notwithstanding the recent marginal recovery) has once again brought to the forefront an inherent weakness existent in our markets. This is the fact that FIIs, indisputably and almost entirely, dominate the Indian stock market sentiments and consequently the market movements. In this article, we make an attempt to list down a few points that would aid an investor in mitigating the risks and curtailing the losses during times of volatility as large investors (read FIIs) enter and exit stocks. Read on Manage greed/fear: This is an important point, which every investor must keep in mind owing to its great influencing ability in equity investment decisions. This point simply means that in a bull run - control the greed factor, which could entice you, the investor, to compromise with your investment principles. By this we mean that while an investor could get lured into investing in penny and small-cap stocks owing to their eye-...
Read more

Debt Funds - Check The Expiry Date

This time we give you an insight into something that most debt fund investors would be unaware of, the Average Portfolio Maturity. As we all know, debt funds invest in bonds and securities. These instruments mature over a certain period of time, which is called maturity. The maturity is the length of time till the principal amount is returned to the security-holder or bond-holder. A debt fund invests in a number of such instruments and each of these instruments would be having different maturity times. Hence, the fund calculates a weighted average maturity, which would give a fair idea of the fund's maturity period. For example, if a fund owns three bonds of 2-year (Rs 30,000), 3-year (Rs 10,000) and 5-year (Rs 20,000) maturities, its weighted average maturity would be 3.17 years. What is the big deal about average maturity then, you may ask. Well, knowing a fund's average maturity is important because it tells you how sensitive a fund is to the change in interest rates. It is ...
Read more
Related Posts Plugin for WordPress, Blogger...
Invest in Tax Saving Mutual Funds Download Any Applications
Transact Mutual Funds Online Invest Online
Buy Gold Mutual Funds Invest Now