Prepared By: Biswajit Chakraborty Roll No.

– 08fc017 IMIS, Bhubaneswar

 A quasi – judicial authority.

 A national service which assists in resolving disputes

between insured and insurers.

 Currently 12 OMBUDSMAN offices in the country.

 Complaints upto Rs.20 lakhs can be filed with the


 Scheme for only individual beneficiaries and not corporate


 The case should not be pending before any other forum

Filing a complaint
 Should be written  Should be filed within a year of rejection by insurer

 First claims should be taken to internal grievance system of

the insurer company.

 Should be filed against the OMBUDSMAN who has

jurisdiction over the region

Characteristics of IOS
 Resolves disputes between consumers and participating


 Free service

 Decisions by IOS are only binding to participating companies

and not consumers.

Empowered to consider following complaints:
 Partial/Total repudiation of claim by insurer  Dispute with regard to premium paid or payable in terms of

 Delay in settlement of claims  Non – issuance of any insurance documents to customers

after receipt of premium

Appointment of OMBUDSMAN
 Govt. bodies of insurance council issue order of appoinment

 Recommended by chairman IRDA, chairman LIC, chairman

GIC, representative of central govt.
 OMBUDSMAN are drawn from Insurance industry, civil

services, judicial services.
 Appointed for 3 yrs or till the incumbant attains 65 yrs,

whichever is earlier.
 No re-appointment .