Ombudsman or consumer court?

The Insurance Ombudsman

• Free, with no lawyer needed. Hearings can be held by video.
• You must first have complained to the insurer in writing, and either been rejected, had no reply within one month, or been unhappy with the reply.
• File within one year of the insurer’s final reply, or of the end of the one-month wait.
• It can award up to ₹50 lakh, including expenses.
• It aims to decide within 3 months of having everything it needs. The award binds the insurer, which must comply within 30 days.

A consumer commission

• Set up under the Consumer Protection Act 2019. You can file online through e-Daakhil.
• The limit is generally 2 years from when the cause of action arose, such as the rejection.
• Commissions sit at district, state and national level, with value limits set under the Act. Most individual claims start at the District Commission.
• It can award compensation beyond the claim amount, but it usually takes longer, and many people use a lawyer.

Choose one

The Ombudsman can’t take a complaint if the same matter is already pending before, or decided by, a court, consumer commission or arbitrator. So decide before filing anywhere.

How people usually decide

• The Ombudsman suits most individual health claims: it is free, fairly quick and doesn’t need a lawyer.
• A consumer commission may suit a claim above the Ombudsman’s limit, a dispute that needs more evidence, or when you have missed the Ombudsman’s one-year window.
• For a court case, talk to a lawyer about your facts.

Questions people ask

Can I go to both the Ombudsman and the consumer court?

Not for the same matter at the same time. The Insurance Ombudsman Rules bar a complaint whose subject is pending before, or decided by, a court, consumer forum or arbitrator.

Is the Insurance Ombudsman free?

Yes. Filing is free, and you don’t need a lawyer.