The government has amended the Insurance Ombudsman Rules 2017 to enable customers to file and track complaints digitally and also attend hearings over video-conferencing.
The amended rules have enlarged the scope of complaints to Ombudsmen; now errors from agents, brokers and other intermediaries (like banks) will also be under the purview of this body, the finance ministry said in a statement.
This means complaints related to policies like servicing, claims or even misselling can also be filed against these intermediaries.
Customers can approach an Insurance Ombudsman within one year of their claim being rejected. Policyholders have to first formally complain to the insurance company and if the insurer does not reply for a month or the reply is unsatisfactory, they can approach the Ombudsman.
The claim limit under Insurance Ombudsman is Rs 30 lakh and it should be a matter that is not being heard under any court or a consumer forum.
Once the customer submits all the relevant documents, the Ombudsman has up to three months to make a decision on the matter. This is binding on all parties. Customers can file complaints only for personal/retail lines of insurance like motor, health or life insurance.
India has currently 16 Ombudsman Centres in places like Mumbai, Pune, Kolkata, Delhi, Chennai, Bengaluru and Jaipur among others.
What are the changes?
Traditionally, policyholders had to physically visit the Insurance Ombudsman office that falls in their jurisdiction for filing complaints and attend hearings. For example, the Ombudsman Office in Mumbai handles complaints of Goa and Mumbai Metropolitan Region while the one in Pune handles complaints of the rest of Maharashtra, Navi Mumbai and Thane.
The coronavirus outbreak had made it impossible for complainants to physically travel to these centres. But policyholders can now register complaints electronically to the Ombudsman and a complaints management system will be created to enable policyholders to track the status of their complaints online.
Further, the Ombudsman can also use video-conferencing for hearings. This means customers can present their grievances from the comforts of their home.
To ensure that top positions at Ombudsman offices don’t stay vacant, a provision has been made for giving additional charge to another Ombudsman.
