[Googleman]

Hello,

My car's comprehensive insurance got lapsed on (11th of May) which was with ICICI Lombard.

Reading the horror stories about ICICI, I went to Bajaj Allianz. The surveyor came and surveyed my car. I did the payment on phone though my credit card when the Insurance person promissed me I will get the insurance receipt in 48 hours. I waited for 4 days and I still did not receive my insurance docs, not a receipt of the payment made.

I tried calling back the insurance guy whom I was in contact with for the insurance, but he never received my calls. If I called from different numbers he hung up as soon as he came to know it's me. I later wrote a mail to few people I know in Bangalore Bajaj branch.

They said the insurance policy which I approached was handled by the head office, Pune branch so they could not do anything. I later called the CFU in Pune branch and told him I don't want the policy any more as their service was even worse than ICICI and I need refund of my money. He confirmed I will get back the refund in 7 days.

It has been more than 3 weeks now, and I did not receive my refund. On writing mails, I just get responses like :-

Dear Sir,
Sorry for delay in reply, we have already processed this refund and have also sent a written to our Accounts team on the same , will ensure that we get back to you with the updated status latest by 4pm today
Mentioned below is the request number of your refund for your ready reference
Request Number:-

Also let me know how to proceed. I am least interested in the money refund. I just want to teach these guys a lesson. Specially the person who hung up on me and did not receive my calls.[/FONT][/COLOR]

[panky12345]

Originally Posted by rjvora_2000

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

Thank you.

In case of partial admission of a motor claim, can one approach Ombudsman and demand money for mental agony too (in addition to the disputed amount??)

[Rehaan]

Jim Peter Saju shared the following story on our Facebook page:

BE THE EMPOWERED CONSUMER!
Posted on April 14, 2016 by peterjim13

Have you ever tried fighting some corporate for their wrong doing or their lack of respect to you as a customer. I have tried once, it may take some time though. And I would proudly say “I won !” and yes I am that bloody customer.

My short note on the same.


Why ? I had some real fight with HDFC Ergo General Insurance for their irresponsible and unprofessional staff and for the hardships they have put me in being a customer. After an accident involving my car and a two-wheeler, my car was put for repairs at the Garage (Kairali Ford, Cochin) for about 43 days to get some not so major work done. Simply because of the insurance providers lack of competence.

After getting everything done to legally locate myself in a position to get the claim without hassles, I had to wait for the mercy of the Surveyor (Arun Kumar, Claims Manager, MG Road Office) who just slept over my claim, bargained for clearing only a part of it. He offered 50% and then 60%, and this went on for a week or more.

That’s when I decided, wait no.. !! These are a few things we are legally bound to win, so decided not to bend myself to these fiasco and to battle it out.

I decided to fight ! With the confidence I gained from a very senior Employee with a Nationalized insurance company, I told the insurance guy that “My car will come out of the garage only through the payment of the works legally covered under insurance paid by your company. I am going to wait, and not gonna help with any other stuff to make your life easier“. This conversation went on for about 3 weeks, I emailed every available email id owned by HDFC Ergo and they too sang the same song like the claims manager.

Relief mid way. At about 20 days post the incident, he called me up and said – that the insurance claim has been awarded and they shall commence the work at the Garage. I thanked him for his understanding and produced all necessary documents for speeding up the claim process at his office. Later at about a week, he again gives me a shocker that the General Diary Entry Issued by the Traffic Police on the incident has a small correction and he is going to reject the claim. This is a document which I handed over on the first day and now he is complaining on the same about a month later. Without delay I go the corrected documents from the police station and then reproduced all the documents with the correction made. This dragged the whole thing to about 30 days and later the Senior Claims Manager intervened to put things move faster and asked me to get the work done and assured me about a reimbursement option within 3 days.

Post the body work. Again to my shock on the 43rd day since the incident, my car comes out of the Garage with about Rs. 4,500 of the total rs. 70,000 declined by the insurance company. This is when I started getting my appeal to the Insurance Ombudsman prepared; collating all the documents, printed copies of emails, extracts from the conversations, proofs etc. I got my car and had to put around 10K from my pocket including the ones which are not covered under insurance.


The Solution :

If you ever had to face such a situation, you always have an option to reach out to The Insurance Ombudsman, who has offices in every state in India. My detailed complaint covered about 64 Pages and got it couriered to the Insurance Ombudsman.

On the 10th day, I get an acknowledgement from the Ombudsman office on the acceptance of my case, and a request response for a consent to proceed with a hearing of the same case. At about 15 days later I get another letter inviting me for the hearing of the case at Calicut (since that was the closest place to my permanent address) and on Feb 17th; I had the hearing at Calicut which got over in about 15 minutes.

The representative of the HDFC Ergo Insurance Company had no claims to make against and agreed to settle the rest of Rs. 4500 which were rejected without any hearing. Still I was given a chance to make the plead and I had also requested for a compensation amounting to Rs. 15000 for the hardships, loss of pay days, and also the cost of travel while I was car less. Ombudsman told me that, there is no room for compensation under this scenario and assured me of justice without delay. But he also suggested me to reach out to IRDA to file a case against the Surveyor who was in turn the claims manager – to produce his certificate (B grade) to ensure whether he was a genuine Insurance Surveyor holding the Certificate. (Which in turn would be my second battle in the line up) The AWARD letter which came in the month of March also had an additional Rs 500 as the travel cost incurred by me, for the hearing (i suppose).

I was given the cheque of the same amount from the Insurance Company on April 4th of 2016, and when I look back at the incident which occurred way back in October 2015.

I am sure that many may see this as some battle which may not be worth it. Especially for those who could afford this 5,000 or may be the whole 70,000.

I am sure that, this may not be something big for the company itself, probably there would be some 1 or 2 of every 20 claims that are taken to the Ombudsman, but as a customer we need not run into court for everything. And need not put down the fight thinking that Court is the only hope. There are parallel bodies like these who help in the same. And it’s not about whether there are ways we could get such things sorted? it’s all about whether we want to make the fight or not!

Always be the empowered customer and not just customer, let the money that our parents spent on our education pay off.

Note : Now I have renewed my Motor Insurance with HDFC Ergo itself, because they would obviously know that – “I know” how they work.

[jinojohnt]

Originally Posted by GTO

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...?

The Ombudsman's decision is binding on the insurance provider (no appeals allowed at higher courts), but the complainant has the right to appeal. See below link for details
https://www.irdai.gov.in/ADMINCMS/cm...eNo233&mid=7.1

The ombudsman shall pass an award within a period of three months from the receipt of the complaint. The awards are binding upon the insurance companies.

If the policy holder is not satisfied with the award of the Ombudsman he can approach other venues like Consumer Forums and Courts of law for redressal of his grievances.

[IronH4WK]

I think the contact for the Insurance Ombudsman has been updated. Found the following on the IRDA website:

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:- bimalokpal.ahmedabad@gbic.co.in
(State of Gujarat and Union Territories of Dadra & Nagar Haveli and Daman and Diu)

BENGALURU
Office of the Insurance Ombudsman,
Jeevan Soudha Building,
PID No.57-27-N-19,
Ground Floor, 19/19, 24th Main Road,
JP Nagar, 1st Phase,
Bengaluru-560 078.
Tel.:- 080-26652048 / 26652049
Email:- bimalokpal.bengaluru@gbic.co.in
(Karnataka)

BHOPAL
Office of the Insurance Ombudsman,
Janak Vihar Complex,
2nd Floor, 6, Malviya Nagar,
Opp.Airtel Office,
Near New Market,
Bhopal – 462 033.
Tel.:- 0755-2769200/201/202
Fax:- 0755-2769203
Email:- bimalokpalbhopal@gbic.co.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:- bimalokpal.bhubaneswar@gbic.co.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 / 2706468
Fax:- 0172-2708274
Email:- bimalokpal.chandigarh@gbic.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.:- 044-24333668 / 24335284
Fax:- 044-24333664
Email:- bimalokpal.chennai@gbic.co.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:- bimalokpal.delhi@gbic.co.in
(State of Delhi)

ERNAKULAM
Office of the Insurance Ombudsman,
2nd floor, Pulinat Building,
Opp. Cochin Shipyard,
M.G. Road,
Ernakulum - 682 015.
Tel.:- 0484-2358759/2359338
Fax:- 0484-2359336
Email:- bimalokpal.ernakulum@gbic.co.in
(Kerala, Lakshadweep, Mahe-a part of Pondicherry)

GUWAHATI
Office of the Insurance Ombudsman,
'Jeevan Nivesh’, 5th Floor,
Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM).
Tel.:- 0361- 2132204 / 2132205
Fax:- 0361-2732937
Email:- bimalokpal.guwahati@gbic.co.in
(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.:- 040-65504123/23312122
Fax:- 040-23376599
Email:- bimalokpal.hyderabad@gbic.co.in
(States of Andhra Pradesh, Telangana and Union Territory of Yanam - a part of the Union Territory of Pondicherry)

JAIPUR
Office of the Insurance Ombudsman,
Jeevan Nidhi-II Bldg.,
Ground Floor,
Bhawani Singh Marg,
Jaipur - 302005.
Tel.:- 0141-2740363
Email:- bimalokpal.jaipur@gbic.co.in
(State of Rajasthan)

KOLKATA
Office of the Insurance Ombudsman,
Hindustan Building Annexe,
4th floor, 4, CR Avenue,
Kolkata - 700 072.
Tel.:- 033-22124339 / 22124340
Fax:- 033-22124341
Email:- bimalokpal.kolkata@gbic.co.in
(States of West Bengal, Bihar, Sikkim 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.:- 0522-2231330 / 2231331
Fax:- 0522-2231310.
Email:- bimalokpal.lucknow@gbic.co.in
(District of Uttar Pradesh: Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur, Varansi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sulanpur, Maharajganj, Santkabirnagar, Azamgarh, Kaushinagar, Gorkhpur, Deoria, Mau, Chandauli, Ballia, Sidharathnagar)

MUMBAI
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.:- 022-26106928/360/889
Fax:- 022-26106052
Email:- bimalokpal.mumbai@gbic.co.in
(States of Goa, Mumbai Metropolitan Region excluding Navi Mumbai & Thane)

NOIDA
Office of the Insurance Ombudsman,
Bhagwan Sahai Palace,
4th Floor, Main Road,
Naya Bans, Sector-15,
Gautam Budh Nagar, Noida
Email:- bimalokpal.noida@gbic.co.in
(States of Uttaranchal and the following Districts of Uttar Pradesh:. Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozabad, Gautam Budh Nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur)

PATNA
Office of the Insurance Ombudsman,
1st Floor, Kalpana Arcade Building,
Bazar Samiti Road,
Bahadurpur,
Patna - 800 006.
Email:- bimalokpal.patna@gbic.co.in
(States of Bihar and Jharkhand)

PUNE
Office of the Insurance Ombudsman,
Jeevan Darshan Building, 3rd Floor,
CTS Nos. 195 to 198,
NC Kelkar Road, Narayan Peth,
Pune - 411 030
Tel: 020 -32341320
Email:- bimalokpal.pune@gbic.co.in
(States of Maharashtra, Area of Navi Mumbai and Thane excluding Mumbai Metropolitan Region)

[ghodlur]

There has been an update on the Insurance Ombudsman rules for 2017 and related FAQ's too. Below is the list of the same as seen from the IRDA website.

1) Who can approach Insurance Ombudsman? What is the procedure for lodging a complaint with an insurance Ombudsman?

Any person including a sole proprietor, micro entrepreneur, members covered in a group insurance policy who has a grievance against an insurer may by himself or through his legal heirs, nominee or assignee or employer as the case may be can approach an Insurance Ombudsman for Redressal of any grievance arising out of an insurance policy by making a complaint in writing to the Insurance Ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential address or place of residence of the complainant is located.


2) What is the meaning of Insurance on Personal Lines?

Insurance on personal lines means an insurance 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.

3) What are the complaints that are entertained by the Insurance Ombudsman?

The Ombudsman will receive and consider complaints or disputes relating to—

(a) delay in settlement of claims, beyond the time specified in the regulations, framed under the Insurance Regulatory and Development Authority of India Act, 1999;
(b) any partial or total repudiation of claims by the life insurer, General insurer or the Health insurer ;
(c) disputes over premium paid or payable in terms of insurance policy;
(d) misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
(e) legal construction of insurance policies in so far as the dispute relates to claim;
(f) policy servicing related grievances against insurers and their agents and intermediaries;
(g) issuance of life insurance policy, general insurance policy including health insurance policy which is not in conformity with the proposal form submitted by the proposer;
(h) non-issuance of insurance policy after receipt of premium in life insurance and general insurance including health insurance; and
(i) any other matter resulting from the violation of provisions of the Insurance Act, 1938 or the regulations, circulars, guidelines or instructions issued by the IRDAI from time to time or the terms and conditions of the policy contract, in so far as they relate to issues mentioned at clauses (a) to (f) .

4) How is the complaint to be lodged?
The complaint shall be made in writing on a plain, duly signed by the complainant and shall state clearly the name and address of the complainant, the name of the branch or office of the insurer against whom the complaint is made, the facts giving rise to the complaint, supported documents if any, the nature and extent of the loss caused to the complainant and the relief sought from the Insurance Ombudsman.

5) Is there any time limit to approach the Insurance Ombudsman?

Yes. No complaint to the Insurance Ombudsman shall lie unless the complaint is made within one year –
Ø From the date of receipt of the order of the insurer rejecting the representation.
Ø From the date of receipt of decision of the insurer which is not to
the satisfaction of the complainant;
Ø After expiry of a period of one month from the date of sending the
written representation to the insurer if the insurer named fails to
furnish reply to the complainant.

6) Is the Insurance Ombudsman empowered to entertain a complaint which is received after the expiry of the specified time limit?

Yes, the Insurance Ombudsman, may, if considered necessary, can condone the delay and after calling for objections of the insurer against the proposed condonation and after recording the reasons for condoning the delay, can entertain a complaint which is received after the expiry of the specified time limit. In such cases, the date of condonation is considered as the date of filing of complaint.

7) What is the Financial Jurisdiction of an Insurance Ombudsman?

Ombudsman can,—

(i) award any compensation up to the loss suffered by the complainant
as a direct consequence of the cause of action; or
(ii) award compensation not exceeding Rs Thirty lakhs (including
relevant expenses, if any).

8) Can a complainant, who has already approached Consumer Forum/court on the same subject, approach the Insurance Ombudsman?

No. Any complainant, whose complaint on the same subject matter is or was before a Court/Consumer Forum or an Arbitrator cannot approach an Insurance Ombudsman.

9) Under what circumstances a complaint can not be filed before and Insurance Ombudsman?

I. No complaint to the Insurance Ombudsman shall lie unless—
the complainant makes a written representation to the insurer named
in the complaint and-
Ø either the insurer had rejected the complaint; or
Ø the complainant had not received any reply within a period of one month after the insurer received his representation; or
Ø the complainant is not satisfied with the reply given to him by the insurer;

II. No complaint before the Insurance Ombudsman can be maintainable on the same subject matter on which proceedings are pending before or disposed of by any court or consumer forum or arbitrator.

10) Should a complainant approach the Ombudsman through a lawyer?

Not necessary as formal court procedures are not involved.

11) Within what time shall the Ombudsman dispose of the complaint?

In case both parties agree for mediation, the Ombudsman gives his Recommendation within 1 month; otherwise, he passes an Award within 3 months from the date of receipt of all requirements from complainant.

12) Are there any fees / charges payable for lodging a complaint?

No fees / charges are required to be paid.

13) Does the Ombudsman conduct hearings of the parties?

Yes, if considered necessary, the Insurance Ombudsman will conduct hearing of both the parties so as to provide them with reasonable opportunity of being heard before an award is passed.

14) Is there any appeal against an Award of Insurance Ombudsman?

In case a complainant is not satisfied with the Award of an insurance Ombudsman he can exercise his right to take recourse to the normal process of law against the insurance company. However, the award of Insurance Ombudsman shall be binding on the insurers.

15) Is there any time limit for Compliance of Award by Insurers?

The Insurer shall comply with the Award within 30 days from the date of receipt of the Award and intimate of its compliance to the Insurance Ombudsman

[DRIV3R]

I am in the process of approaching the ombudsman in my jurisdiction with a complaint against my insurance provider for claim rejection.

Just wanted to know the preferred mode of complaint, it would be written as we know, but does it make sense to hand over the written complaint in person to the ombudsman over say mailing it through registered post? This thought is mainly to fill any gaps the ombudsman may have after going through the complaint. If it would not make any difference, I would rather send it across through registered post. Please suggest.

[ontheway]

Originally Posted by DRIV3R

Just wanted to know the preferred mode of complaint, it would be written as we know, but does it make sense to hand over the written complaint in person to the ombudsman over say mailing it through registered post?

Hey, just came across your question, which is although some 20 days old. If you are still considering it, here is the suggestion based on my practical experinece with Delhi Ombudsman, but for medical insurance complaint.

I had first emailed them the complete complaint with all the attachments. Then I took a print out of that mail and attached it along with the main complaint and necessary documents and sent it via Speed Post to the Ombudsman office. After some 15 days, I got the acknowledgement on email that complaint has been received, along with list of all the documents which are required to be submitted to process the complaint further.

At this point, I decided to atleast one time visit the office to understand the further process. I took all the required documents and went to the Ombudsman Office, after calling to confirm that the officer incharge will be available. The officers there are allocated specified Insurers and my concerned officer was a helpful gentleman who first understood my complaint and then collected all the necessary documents. He then informed me the process and expected timeline for hearing. You can either send documents via Speed Post or meet the officer like I did. In my experinece, meeting the officer is helpful in making him understand the whole issue and process the complaint little faster.

After some 15-20 days, I received one more letter by post from the Ombudsman, asking for final consent to mediation and hearing. You can send that reply by Speed Post or submit by hand. After this, you will be allocated the date of hearing, which in my case was within next one month.

Whole process in total takes within within 3 months in Delhi, as per my experience. Waiting for my hearing though.

Good luck!