Agents, brokers & intermediaries now included under insurance Ombudsman ambit: Pushpha Girimaji

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Government on Wednesday amended Insurance Ombudsman Rules, 2017, for better resolution of policyholders’ complaints. In a conversation with Money9 Pushpa Girimaji, a specialist in consumer law and consumer safety, explains in detail what these amendments are:

What is the role of insurance Ombudsman and why is it important?

It is a dispute redressal system. What happens is whenever, you know, you make a claim and if the insurance company, rejects that claim , then you talk to them again. So where insurance company fails to address your grievance, the insurance industry provides you with an ombudsman who will look at your complaint. So, it’s basically an alternate agreement through the system for policy holders, and nominees.

What are the amendments to the insurance Ombudsman rules?

Earlier, the scope of the ombudsman was limited. And now they’ve brought in agents, brokers, and various intermediaries. That is welcome because now whenever there is such a dispute, consumers can go to the ombudsman. They have also strengthened the process of selection of ombudsman.

They have, in fact, added consumer activists in the selection committees to make it quite impartial. Because, at one time the allegation was that only people from the insurance industry used to become ombudsman.

So, now what they have done is they have come up with the committee that will recruit a Ombudsman. They have also made provisions for not just people from the insurance industry but also people from administrative and other services.

What these amendments say about filing the complaint electronically?

Now, there is no physical process. One can electronically file a complaint. That’s also one of the major initiatives in the new notification. Under the banking ombudsman scheme, for example, one could file complaints from the very beginning, electronically.

How can one file a complain to Ombudsman?

Basically what you need to do is first, when you have a complaint, you must write to the insurance company. Insurance companies have these nodal officers to whom you can address the complaint. And if you’re not satisfied with the result, a reply that they give you or if you don’t get a reply within 30 days, then you can go to the insurance Ombusdman. And then the filing is really easy. You just have to write it down. You don’t need a lawyer to represent your case. They have to decide the case within 30 days. There is a time limit of one year for you to file a complaint that is after the rejection, whatever is the cause, for filing a complaint.