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Insurance claims: Pending claims at ombudsman office a thing of the past

Number of complaints coming to Ombudsman has seen a reduction

M Saraswathy  |  Mumbai 


In the last three years, the office of the insurance ombudsman here has handled about 21,000 cases till now, and has reduced the backlog in a significant manner.

A K Dasgupta, ombudsman, explained that they have been able to clear out of the huge backlog. “Earlier, we were handling cases which were almost three years prior to that date. But we have been holding several sessions of grievance resolution and this has brought down the backlog. Now, we are able to settle cases within 90 days from the day of receipt of the necessary documents from the complainant.”

The office here has Goa, Mumbai Metropolitan Region excluding Navi Mumbai and Thane under its jurisdiction. It handles one of the highest number of cases yearly. In 2015-16, up to October 31 alone, it handled 2,861 complaints. In last financial year, it handled 5,471 complaints. Overall, Dasgupta also said the number of complaints coming to the ombudsman has seen a reduction. "This is because a lot of complaints are being settled at the insurance companies level itself," he added. Apart from having a staff on board to handle complaints, ombudsman offices also interact with doctors to get a better opinion on cases related to health insurance. They also interact with consumer activists.

The insurance ombudsman scheme was created by the Centre for individual policyholders to have their complaints settled out of the courts system in a cost-effective, efficient and impartial way. There are 17 insurance ombudsmen.

Dasgupta said in life insurance, majority of complaints comes from misselling of policies followed by repudiation of death claims. In general insurance, a majority of complaints are from health insurance claims, followed by motor claims. The forum acts through a process of mediation. On many occasions, the cases are resolved without personal appearance of the disputing parties by interacting with the companies. But in several other cases both the complainant and company are called for personal deposition and submission of supporting evidences.

“We even have a fast-track system for disposal of cases for senior citizens above 70 years of age and also have priority handling of cases pertaining to critical illness,” he added.

Ramma Bhasin, the secretary general of the office of the Governing Body of Insurance Council (GBIC), said now they have 130 people in total in all ombudsman offices. The GBIC has been established under Redressal of Public Grievances Rules 1998.

  • First write to the grievance redressal officer of the insurer. It should deal with your complaint within 30 days
  • If you are unhappy with the solution or if there is no response to your complaint for 30 days, you can approach the ombudsman for value of the claim, including expenses not exceeding Rs 20 lakh , within one year from date of rejection/repudiation/partial settlement of claim by the insurer
  • There are 17 insurance ombudsmen in India. There is no fee
  • You should not have approached any other forum/court/arbitrator on the same subject

First Published: Fri, December 11 2015. 00:24 IST