Is your insurance company taking you on a ride by delaying or repudiating in settling your claim. You need to spend sleepless nights now. The Insurance ombudsman office will take care of it. Established by Insurance Regulatory and Development Authority Ombudsmen are arbitrators for insurance related disputes, to be resolved quickly and at a low cost. Today, there are 12 offices of ombudsman across the country.

Before the setting up of the office of the insurance ombudsman before November 1999. One had to file a case with a consumer forum or a civil suit. Both steps were expensive and time-consuming, given the backlog of cases and the fact that insurance claims, at any rate, only get perfunctory attention in courts.

Functions
In Nov 1998 a notification was issued by the government for setting up ombudsmen’s offices in the country. So, according to that, the governing body of the insurance council viz the representatives of various insurance companies transacting life and non life insurance business in the country formed the insurance council. That insurance council was empowered to appoint the insurance ombudsmen in the country and the insurance council.

The entire process of arbitration has been kept simple. Any insurance-related complaint can be filed; for now, however, the ombudsman entertains only complaints in respect of claims up to Rs 20 lakh relating to individual life or non-life policies, so long as they're of a non-commercial nature.

Once a complaint is filed and the ombudsman finds a prima facie case, a response is sought from the insurer within 14 days. With that, the redress mechanism gets going. The claim may be settled in one of three ways: immediate settlement on reference, settlement following mediation, and settlement through mediation and award.

Mediation becomes necessary when the insurer contests the complainant's claim before the ombudsman. In such cases, the ombudsman investigates the complaint and gives guidelines for a settlement within a month. A copy is sent to both parties. If the recommendation is acceptable to the petitioner, she must confirm her acceptance within 15 days to enable a final settlement of her claim; the ombudsman directs the insurer to implement the recommendation within 15 days. Likewise, if the insurer accepts the recommendation, it has to comply within 15 days.

However, if the insurance company does not comply with the recommendations, the ombudsman can declare an award, which has to be honoured within 15 days of receiving the acceptance letter from the complainant.

Is the award binding? The IRDA has the power to exempt an insurance company from the authority of the Ombudsman only if the company has a credible alternative arbitration mechanism. No insurer has yet sought such exemption.

Significantly, an ombudsman's award is not binding on the complainant; so if the verdict does not uphold your claim, you still have the option of approaching a court of law or a consumer forum. But, remember: you may be on infirm ground if the insurer cites the ombudsman's ruling to buttress its case.

How to file a complaint. There is no prescribed format for filing complaints. All it requires is for you to submit your complaint in writing, stating the facts, with documentary proof to back your claim. If your complaint is taken up, the settlement process will get under way without even requiring your presence. Only if the case goes to the mediation stage will you be required to attend a hearing in the ombudsman's office, to present your case. And you don't need a lawyer to represent you.

The process is simple file a written complaint with the insurer company. Your complaint to the ombudsman must be filed within a year of rejection of a claim by the insurer. The ombudsman intervenes only if you’ve not moved to the courts or approached a consumer forum You must file your complaint with the ombudsman who has jurisdiction over the region in which you have bought the policy.

The complainant or any person on his behalf can complain to the ombudsman giving a brief account of what exactly are his grievances but before looking at the complaint, the ombudsman has to see a few points like whether it is really a time barred complaint as the complaint has to be filed within a year of rejection of a claim by the insurer, another point to be kept in mind is that before coming to the ombudsman the complainant should have made a representation to the insurance company and received a reply which is not satisfactory or the representation has been rejected or there is no reply atleast for a month or so and again the most important thing is that he should not have gone to any other forum before coming to the ombudsman for eg a consumer forum etc.

The reason for ensuring that the complainant has not already gone to any other forum before coming to the ombudsman as an alternate avenue he has already been thought of by him so the ombudsman then has no powers to entertain him. As one complaint is already pending before the redressal forum on the same subject then the ombudsman has no powers. Suppose the complaint has already been rejected by a consumer forum then can the complainant approach the ombudsman? Certainly not, as either it has already been rejected or it is pending, the ombudsmen cannot entertain the complaint.

What are the restrictions for the ombudsman?
The restrictions are that they cannot complain against anything under the sun, they can complain only in respect of a few items which have been prescribed in the notification and that also mostly relates to claims. Claims includes the delay in the time to settle the claim, supposing the company takes a very long time to settle the claims, they can come to ombudsmen with subject to, the above mentioned points where they should have made a representation, not have gone to consumer court, one year should not have elapsed, all these conditions are to be met with. Then also against repudiation, whether it is a total repudiation, or a part settlement/ part repudiation. There is also a clause wherein they can come to an ombudsman on the legal construction of the policies in so far as they relate to claims. Also on non-issue of documents after receipt of premium. Premium itself can be a subject matter of dispute – premiums paid or premiums payable. So check before you file your complaint.

Jurisdiction	Office Address
Delhi, Rajasthan	First Floor, Universal Insurance Building, Asaf Ali Road, New Delhi 110002
West Bengal, Bihar	29, N.S. Road, Third Floor, Kolkata
Maharashtra	101, Arun Chambers, Tardeo Main Road, Mumbai 400034
Tamil Nadu, Pondicherry	Fatima Akhtar Court, Fourth Floor, 312 Anna Salai, Chennai 600018
Andhra Pradesh	6-2-47, Yeturu Towers, A.C. Guards Lakdi-Ka-Pool, Hyderabad 500004
Gujarat	Second Floor, Shree Jayshree Ambica House, 5, Navyug College, Ashram Road, Ahmedabad 380014
Kerala, Karnataka	Pulinat Building, Second Floor, M.G. Road, Kochi 682015
North-Eastern States	Aquanus, Bhaskar Nagar, R.G. Baruah Road, Guwahati 781021
Uttar Pradesh	Chintal House, First Floor, 16 Station Road, Lucknow 226001
Madhya Pradesh	First Floor, 117 Zone 2, Maharana Pratap Nagar, Bhopal 462011
Punjab, Haryana, Himachal Pradesh,Jammu & Kashmir, Chandigarh	Batra Building, Shop-cum-Office 101-103, Second floor, Sector 17D, Chandigarh
Orissa	62, Forest Park, Bhubaneswar 751009

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