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Old 29th March 2010, 09:05   #1
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Lightbulb Frequently Asked Questions (FAQs) On Insurance Ombudsman And Its Working:

Dear Friends,

Working of ombudsman is very simple, please read this FAQ and you will come to know the same.

Thank you.

1) With whom is a complaint to be lodged?
A complaint is to be lodged with the Insurance Ombudsman under whose territorial jurisdiction.

2) Does Insurance Ombudsman operate in any territorial jurisdiction?
Yes. Insurance Ombudsman operates only within the territorial limits.

3) How is this territorial jurisdiction to be applied to complaints?
The complaint will lie with the Insurance Ombudsman under whose territorial jurisdiction the Branch or Office of the Insurer complained against is located. However, in case of Group Insurance policies, the complaint may be lodged with the Insurance Ombudsman under whose territorial jurisdiction the place of residence of the complainant falls.

4) Who can approach Ombudsman?
Any aggrieved individual who has taken an Insurance Policy on personal lines (or if deceased, the legal heir(s) under such policy) can approach Ombudsman.

5) What is the meaning of Insurance on Personal Lines?
Insurance on personal lines means a policy taken or given in an individual capacity, e.g. life insurance, personal accident insurance, mediclaim insurance, insurance of personal property of the individual such as motor vehicle, household articles, etc.

6) What are the complaints that are entertained by the Ombudsman?
Complaints pertaining to repudiation of claims totally or partially, delay in settlement of claims, any dispute on the legal construction of the policies in so far as such disputes relate to claims, disputes regarding premiums paid / payable and non-issue of insurance documents.

7) How is the complaint to be lodged?
The Complaint is to be made in writing and may be lodged through personal approach or through post / fax / email(followed by hard copy).

8) Is there any time limit to approach the Ombudsman?
Yes. Within one year of the rejection by the insurer of the representation of the complainant or the Insurer's final reply to the representation.

9) Is there any maximum limit for the amount under dispute that can be entertained by the Ombudsman?
Yes. The maximum limit for the amount under dispute for which the Ombudsman can entertain a complaint is upto Rs. 20 lakhs.

10) Can a complainant, who has already approached Consumer Forum/court on the same subject, approach the Ombudsman?
No. Any complainant, whose complaint on the same subject matter is or was before a Court/Consumer Forum cannot approach Ombudsman.

11) What are the pre-requisite conditions in short, for lodging a complaint?

1. The complaint must be by an individual on a ‘Personal Lines’ insurance and within the terms of reference of the Insurance Ombudsman as set out under FAQ 6.
2. A representation should stand made to the Insurance Company and either an unsatisfactory reply should have been received or the representation should stand unreplied for at least 1 month.
3. The complaint must be lodged within 1 year of the events mentioned in b. above
4. The total relief sought must be within an amount of Rs.20 lakhs.
5. The subject matter of the complaint should not currently be or have earlier been before a Court/Consumer Forum.

12) Should a complainant approach the Ombudsman through a lawyer?
Not necessary, as formal court procedures are not involved.

13) Within what time shall the Ombudsman dispose off the complaint?
In case both parties agree for mediation, the Ombudsman shall give his Recommendation within 1 month, otherwise, he shall pass his Award within 3 months.

14) Can the Ombudsman award ex-gratia payment?
Yes. If the Ombudsman deems it fit in the circumstances of the case, he may award ex-gratia payment.

15) Are there any fees / charges payable for lodging a complaint?
No fees / charges are required to be paid.

16) Does the Ombudsman conduct hearings of the parties?
Yes. Wherever considered necessary, the Ombudsman will conduct hearing of both the Parties.

17) If so, can the hearings be conducted outside headquarters?
Yes. Hearings may be conducted outside headquarters, where warranted.

18) Can a complaint be lodged against a Private Insurer?
Yes. Complaints can be lodged against any Insurer both in Public Sector and Private Sector in both Life and Non-Life sectors.

19) Can a Sole-Proprietor of a business approach the Ombudsman for a complaint arising out of business interests?
No. It was clarified in 2006 that since in such cases the subject matter of insurance is a commercial interest, the insurance policy thereon cannot be deemed to fall under the definition of personal lines insurance.

20) Can Partnership Firms/Corporate Clients/Co-operative Societies/ Associations/Trusts approach Ombudsman?
No. Only individual policyholders who have taken insurance on personal lines are eligible. However, a member covered under a Master Policy or a Group Insurance (or if deceased, the legal heir) can approach the Ombudsman, provided the payment of the claim under such policy is to be made to the individual, as beneficiary.

21) Is there any appeal against a decision given by the Ombudsman?
No, as the Recommendation or Award of the Insurance Ombudsman are both subject to acceptance by the complainant in full and final settlement of the complaint. If such acceptance is not agreeable, the complainant may exercise the right to take recourse to the normal process of law against the insurance company. Further, dismissal of a complaint by the Insurance Ombudsman, does not vitiate the complainants’ right to seek legal remedy against the insurers complained against, as per normal process of law.

22) Are routine administrative issues concerning agents (like non-issue of licence, non-receipt of commission etc.) or employees’ grievances or policy servicing matters(like transfer of policies etc.) and complaints against staff of the member companies also entertained by the Ombudsman?
No. Such matters do not fall within the terms of reference of the Ombudsman and hence are not to be referred.

23) Are copies of complaints or queries and correspondence related thereto required to be forwarded to the Office of the Governing Body of Insurance Council?
No. The Ombudsman deals directly with complaint matters.

24) Can information be sought under the Right to Information Act?
Yes, where required, information can be sought from the Public Information Officer of the concerned Ombudsman Centre in the prescribed format, forwarded together with the requisite prescribed fee. The Appellate Authority vests with a higher ranking official from the concerned Ombudsman Centre.
In the case of Governing Body of Insurance Council, information can be sought from the Public Information Officer of the Office of the Governing Body of Insurance Council in the prescribed format, forwarded together with the requisite prescribed fee. The Appellate Authority vests with the Dy. Secretary-in-charge or Dy. Secretary-General or Secretary-General (as the case may be) of the Governing Body of Insurance Council.
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Old 29th March 2010, 10:22   #2
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R J Vora Sir, thanks a lot man.

I am sure there will be a lot more questions to be added on here.

Thanks again. Will help a lot of folks gain confidence in resolving thier issues.
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Old 29th March 2010, 17:39   #3
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Learn something new everyday! Thanks for the fantastic article, Rjvora. Rated this thread 5 stars.

One very important question on the power of the Ombudsman : What if their ruling is in favour of the complainant, and the insuring company is (obviously) not happy with it. Does the insurer have to comply with the ruling, or...?

Also, how similar / different is this to say, arbitration?
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Old 30th March 2010, 01:42   #4
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^^^From the wording, it seems the ruling is binding on the Insurer. The complainant however reserves the right to file a case in a court of law.
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Old 30th March 2010, 09:10   #5
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Yes, Insured and Insurer both can re-appeal. I have been told this by 2 Branch manager of different insurer in the past 4 year's + till now non of the insurance company have re-appeal the judgment issued by insurance ombudsmen.

There can be many reasons to this few can be: -
1. Small claims amount. (Less then Rs. 20,00,000/-)
2. There is always a reason which is given along with the claims settlement.
3. Insurance companies also have to pay for the legal charges if they re-appeal. (If they loose the case then they have to compensate the insured again.) This is a double loss to them.
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Old 30th March 2010, 09:43   #6
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Hi,

Great thread , It will be great if Someone can publish Address contact points for insurance ombudsman in different jurisdiction.


Regards
Amit
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Old 30th March 2010, 10:01   #7
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Default Postal Address, Phone no. and E-mail.

GOVERNING BODY OF INSURANCE COUNCIL

Office of the Governing Body of Insurance Council
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.:- 022-26106245/889/671
Fax:- 022-26106949
Email:- inscoun@gmail.com

AHMEDABAD
Office of the Insurance Ombudsman,
2nd floor, Ambica House,
Near C.U. Shah College,
5, Navyug Colony, Ashram Road,
Ahmedabad – 380 014
Tel.:- 079-27546150/139
Fax:- 079-27546142
Email:- ins.omb@rediffmail.com
State of Gujarat and Union Territories of Dadra & Nagar Haveli and Daman and Diu.

BHOPAL
Office of the Insurance Ombudsman,
Janak Vihar Complex,
2nd Floor, 6, Malviya Nagar, Opp. Airtel,
Bhopal – 462 011.
Tel.:- 0755-2769200/201/202
Fax:- 0755-2769203
Email:- bimalokpalbhopal@airtelmail.in
States of Madhya Pradesh and Chattisgarh.

BHUBANESHWAR
Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar – 751 009.
Tel.:- 0674-2596461/2596455
Fax:- 0674-2596429
Email:- ioobbsr@dataone.in
State of Orissa.

CHANDIGARH
Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd Floor,
Batra Building, Sector 17 – D,
Chandigarh – 160 017.
Tel.:- 0172-2706196/5861/6468
Fax:- 0172-2708274
Email:- ombchd@yahoo.co.in
States of Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir and Union territory of Chandigarh.

CHENNAI
Office of the Insurance Ombudsman,
Fatima Akhtar Court,
4th Floor, 453 (old 312), Anna Salai, Teynampet,
CHENNAI – 600 018.
Tel.:- 044-24333678/664/668
Fax:- 044-24333664
Email:- insombud@md4.vsnl.net.in
State of Tamil Nadu and Union Territories - Pondicherry Town and Karaikal (which are part of Union Territory of Pondicherry).

DELHI
Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi – 110 002.
Tel.:- 011-23239611/7539/7532
Fax:- 011-23230858
Email:- iobdelraj@rediffmail.com
States of Delhi and Rajasthan.

GUWAHATI
Office of the Insurance Ombudsman,
’Jeevan Nivesh’, 5th Floor,
Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM).
Tel.:- 0361-2132204/2131307/2132205
Fax:- 0361-2732937
Email:- ombudsmanghy@rediffmail.com
States of Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura.

HYDERABAD
Office of the Insurance Ombudsman,
6-2-46, 1st floor, "Moin Court"
Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad - 500 004.
Tel.:- 040-23325325/23312122
Fax:- 040-23376599
Email:- insombudhyd@gmail.com
States of Andhra Pradesh, Karnataka and Union Territory of Yanam - a part of the Union Territory of Pondicherry.

KOCHI
Office of the Insurance Ombudsman,
2nd Floor, CC 27 / 2603, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Ernakulam - 682 015.
Tel.:- 0484-2358734/759/9338
Fax:- 0484-2359336
Email:- iokochi@asianetindia.com
State of Kerala and Union Territory of (a) Lakshadweep (b) Mahe-a part of Union Territory of Pondicherry.

KOLKATA
Office of the Insurance Ombudsman,
North British Bldg., 3rd Floor,
29, N. S. Road,
Kolkata - 700 001.
Tel.:- 033-22134869/67/66
Fax:- 033-22134868
Email:- iombsbpa@bsnl.in
States of West Bengal, Bihar, Sikkim, Jharkhand and Union Territories of Andaman and Nicobar Islands.

LUCKNOW
Office of the Insurance Ombudsman,
6th Floor, Jeevan Bhawan,
Phase-II, Nawal Kishore Road, Hazratganj,
Lucknow-226 001.
Tel.:- 0522-2201188/31330/1
Fax:- 0522-2231310
Email:- insombudsman@rediffmail.com
States of Uttar Pradesh and Uttaranchal.

MUMBAI
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.:- 022-26106928/360/6552/6960
Fax:- 022-26106052
Email:- ombudsmanmumbai@gmail.com
States of Maharashtra and Goa.
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Old 30th March 2010, 10:53   #8
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Excellent info! Will help a lot of people.

Cheers,
gpa
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Old 30th March 2010, 17:53   #9
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Fantastic dear! Five stars!!
Do you know if there is an office of the Governing Body of Insurance Council in Bangalore?

Last edited by Iluvcars : 30th March 2010 at 17:55.
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Old 31st March 2010, 08:23   #10
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Quote:
Originally Posted by Iluvcars View Post
Do you know if there is an office of the Governing Body of Insurance Council in Bangalore?
It cannot be. - I think that is a head office of Ombudsman so there wont be any other then in Mumbai.
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Old 31st March 2010, 08:33   #11
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Rupesh,

Thanks a lot for the fantastic info. This info surely needs a 5 star rating. I have already taken a printout and kept it in my imp doc files.
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Old 31st March 2010, 08:41   #12
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Quote:
Originally Posted by gpa View Post
Excellent info! Will help a lot of people.
Quote:
Originally Posted by Iluvcars View Post
Fantastic dear! Five stars!!
Quote:
Originally Posted by ghodlur View Post
I have already taken a printout and kept it in my imp doc files.
Thank you all very much for compliments. These word's of encouragements helps me, to do more.
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Old 31st March 2010, 09:45   #13
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Excellent thread already voted 5*.
I think mods should put this thread as a sticky so it will be helpful to everyone.
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Old 8th April 2010, 10:03   #14
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This is fantastic info Rupeshji. Rated 5 stars.

Have passed on the link to this page to all the contacts in my address book.
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Old 29th April 2010, 13:52   #15
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Excellent thread Rupesh! Five stars from my side too.
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