I am facing problems regarding a policy of mine. What is the procedure for filing a complaint with an insurance ombudsman?
Virabhadran Ramsamy, Hyderabad
There is no prescribed format for filing complaints. You can submit it in writing on a plain paper, stating the facts, with documentary proof. If your complaint is taken up, the settlement process will get underway without even requiring your presence.
In case it goes to the mediation stage, you will be required to attend a hearing in the ombudsman’s office to present your case. A lawyer is not needed to present your case. You must bear the following points in mind before filing the complaint.
The complaint must be filed within a year of rejection of your claim by the insurer. The ombudsman intervenes only if you have not moved the courts or approached a consumer forum. The complaint has to be filed with the ombudsman who has jurisdiction over the region in which you bought the policy. Once a complaint is filed and the ombudsman finds a prima facie case, a response is sought from the insurer within 14 days. A claim may be settled in one of three ways: immediate settlement on reference, settlement following mediation and settlement through mediation and award.
An ombudsman’s verdict is not binding on the complainant. If your claim is not upheld, you can approach a court of law or a consumer forum.
