What if your

complaint is denied
by the insurance
company?

INSURANCE OMBUDSMAN BY

D.PRIYANKA
121933101010
 When and why was the insurance
ombudsman scheme established?

• Insurance ombudsman was established on 11th November,

1998.

• The main purpose to establish insurance ombudsman is to

protect the interests of policyholder by resolving the
grievances faced by the policyholder.

• There are 12 insurance ombudsman offices in India.

Appointment of insurance ombudsman:

GBIC Committee

1. Chairman of Insurance Regulatory

and Development Authority (IRDA)

2. Chairman of life insurance

corporation of India (LIC)

3. Chairman of General insurance

corporation of India (GIC)

4. Representative of the central

government
 Eligibility and terms of office:
• To become an insurance ombudsman a person must be an
expert in the
a) insurance industry
b) civil services
c) Judicial services
d) other fields

• Fixed term of 3 years till the person attains 65 years of age.

• No re-appointment is permitted.
When to lodge a complaint to an insurance
ombudsman?
• The complaint can be lodged when the-

A. Insurance company has rejected the prior complaint.

B. Insurance company did not react for 30 days.
C. Policyholder is not satisfied with the decision of the
insurance company.
D. The value of claim including expenses is not above 20
lakhs.
 How does an ombudsman help in claim
settlement?
• The settlement process is divided into 2 ways they are-

1. Recommendations – within 30 days

2. Award – within 3 months

Policy holder will be given 15 days to accept or revert the
decision by ombudsman