How to complain to the Insurance Ombudsman.

Are you eligible?

• You first complained in writing (letter, email or online) to the insurer.
• The insurer rejected your complaint, did not reply within one month of receiving it, or you are not satisfied with its reply.
• The compensation you seek, including expenses, is up to ₹50 lakh. That is a limit on what the Ombudsman can award, not on the size of your policy or bill.
• The same matter is not pending before, or decided by, a court, consumer commission or arbitrator.

The deadline

File within one year of the insurer’s rejection of your complaint, or of an unsatisfactory reply, or of the end of the one-month wait if the insurer didn’t reply. The Ombudsman can condone a delay after hearing you, but don’t count on it.

What you can complain about

• Full or partial rejection of a claim
• Delay in settling a claim beyond the regulatory timelines
• Misrepresentation of policy terms
• How the policy wording should be read as it relates to a claim

Documents to attach

• Your letter to the insurer’s Grievance Redressal Officer
• The insurer’s reply, or its rejection or settlement letter
• The policy, or certificate of insurance for a group policy
• Supporting proof: discharge summary, bills, earlier policy schedules if ported

How to file

1. Go to cioins.co.in and choose the online complaint, or email the Ombudsman office for the insurer’s branch or your place of residence.
2. Fill in your details, the insurer and branch, and the facts with documents.
3. State the relief you want: the claim amount and interest.
4. Attend the hearing, which can be by video conference. Mediation is possible if both sides agree.

After the award

The Ombudsman aims to decide within 3 months of receiving everything from you. The insurer must comply within 30 days and pay interest at 2% above bank rate from the date the claim should have been settled. If it doesn’t comply, it owes you ₹5,000 per day of delay. Filing is free.