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Thread: Insurance ombudsman

  1. #1
    Join Date
    Sep 2008
    Posts
    2,988

    Default Insurance ombudsman

    INSURANCE OMBUDSMAN

    The institution of Insurance Ombudsman was created by the Government of India vide its notification dated 11th November, 1998 to handle complaints of aggrieved insured persons. Claimants who could not get their complaints redressed by insurers may get in touch with the Ombudsman relevant to their states.

  2. #2
    Join Date
    Sep 2008
    Posts
    2,988

    Default

    Brief note on the functioning of the offices of the Insurance Ombudsman


    The institution of Insurance Ombudsman was created by a Government of India Notification dated 11th November, 1998 with the purpose of quick disposal of the grievances of the insured customers and to mitigate their problems involved in redressal of those grievances. This institution is of great importance and relevance for the protection of interests of policy holders and also in building their confidence in the system. The institution has helped to generate and sustain the faith and confidence amongst the consumers and insurers.

    Appointment of Insurance Ombudsman

    The governing body of insurance council issues orders of appointment of the insurance Ombudsman on the recommendations of the committee comprising of Chairman, IRDA, Chairman, LIC, Chairman, GIC and a representative of the Central Government. Insurance council comprises of members of the Life Insurance council and general insurance council formed under Section 40 C of the Insurance Act, 1938. The governing body of insurance council consists of representatives of insurance companies.

    Eligibility


    Ombudsman are drawn from Insurance Industry, Civil Services and Judicial Services.

    Terms of office


    An insurance Ombudsman is appointed for a term of three years or till the incumbent attains the age of sixty five years, whichever is earlier. Re-appointment is not permitted..

    Territorial jurisdiction of Ombudsman


    he governing body has appointed twelve Ombudsman across the country allotting them different geographical areas as their areas of jurisdiction. The Ombudsman may hold sitting at various places within their area of jurisdiction in order to expedite disposal of complaints. The offices of the twelve insurance Ombudsmans are located at (1) Bhopal, (2) Bhubaneswar, (3) Cochin, (4) Guwahati, (5) Chandigarh, (6) New Delhi, (7) Chennai, (8) Kolkata, (9) Ahmedabad, (10) Lucknow, (11) Mumbai, (12) Hyderabad. The areas of jurisdiction of each Ombudsman has been mentioned in the list of Ombudsman.

    Office Management

    The Ombudsman has a secretarial staff provided to him by the insurance council to assist him in discharging his duties. The total expenses on Ombudsman and his staff are incurred by the insurance companies who are members of the insurance council in such proportion as may be decided by the governing body.

    Removal from office

    An Ombudsman may be removed from service for gross misconduct committed by him during his term of office. The governing body may appoint such person as it thinks fit to conduct enquiry in relation to misconduct of the Ombudsman. All enquiries on misconduct will be sent to Insurance Regulatory and Development Authority which may take a decision as to the proposed action to be taken against the Ombudsman. On recommendations of the IRDA, the Governing Body may terminate his services, in case he is found guilty.

    Power of Ombudsman

    Insurance Ombudsman has two types of functions to perform (1) conciliation, (2) Award making. The insurance Ombudsman is empowered to receive and consider complaints in respect of personal lines of insurance from any person who has any grievance against an insurer. The complaint may relate to any grievance against the insurer i.e. (a) any partial or total repudiation of claims by the insurance companies, (b) dispute with regard to premium paid or payable in terms of the policy, (c) dispute on the legal construction of the policy wordings in case such dispute relates to claims; (d) delay in settlement of claims and (e) non-issuance of any insurance document to customers after receipt of premium.

    Ombudsman's powers are restricted to insurance contracts of value not exceeding Rs. 20 lakhs. The insurance companies are required to honour the awards passed by an Insurance Ombudsman within three months.

    Manner of lodging complaint

    The complaint by an aggrieved person has to be in writing, and addressed to the insurance Ombudsman of the jurisdiction under which the office of the insurer falls. The complaint can also be lodged through the legal heirs of the insured. Before lodging a complaint:

    i) the complainant should have made a representation to the insurer named in the complaint and the insurer either should have rejected the complaint or the complainant have not received any reply within a period of one month after the concerned insurer has received his complaint or he is not satisfied with the reply of the insurer.
    ii) The complaint is not made later than one year after the insurer had replied.
    iii) The same complaint on the subject should not be pending with before any court, consumer forum or arbitrator.

    Recommendations of the Ombudsman

    When a complaint is settled through the mediation of the Ombudsman, he shall make the recommendations which he thinks fair in the circumstances of the case. Such a recommendation shall be made not later than one month and copies of the same sent to complainant and the insurance company concerned. If the complainant accepts recommendations, he will send a communication in writing within 15 days of the date of receipt accepting the settlement.

    Award

    The ombudsman shall pass an award within a period of three months from the receipt of the complaint. The awards are binding upon the insurance companies.

    If the policy holder is not satisfied with the award of the Ombudsman he can approach other venues like Consumer Forums and Courts of law for redressal of his grievances.

    As per the policy-holder's protection regulations, every insurer shall inform the policy holder along with the policy document in respect of the insurance Ombudsman in whose jurisdiction his office falls for the purpose of grievances redressal arising if any subsequently.

    Steady increase in number of complaints received by various Ombudsman shows that the policy-holders are reposing their confidence in the institution of Insurance Ombudsman.

  3. #3
    Prasad Kulkarni Guest

    Default Complaint against HDFC Life standard insurance co.ltd.

    Respected
    Sir,
    I had applied for HDFC life Pro growth plus policy (No. 16051496) at HDFC Standard Life Insurance Co. Ltd.,. I
    had bee informed that I can cancel my policy within 30 days after
    reception of policy documents by courier by the policy agent.
    same thing is confirmed by the executive in 'confirmation' call received
    after my application.


    I received original policy documents on 13 / 05 /2013. After reading
    terms & conditions, I decided to cancel the policy as I was not
    agree with it.
    Also I found that lookin period (cancellation period) mentioned is both
    30 days & 15 days for different channels. I was not sure about the
    channel applicable to me, so I called customer care on 23 / 05/ 2013
    (after 10th day of policy received date) for confirmation about lookin
    period. I got the information that I can cancel the policy within 30
    days. I requested to confirm once again & same was confirmed by the
    customer care executive.
    So I visited the Company's Aundh (pune) branch on 29 /05 /2013 (after
    16th day of policy received date)with original & other necessary
    documents, but my request denied with the reason that I have exceeded
    maximum lookin period of 15 days.

    later on I continuously requested to cancel the policy by Emails, but
    company denied my request.

    Please help me in this matter.

    Regards,
    Prasad Kulkarni

  4. #4
    Unregistered Guest

    Default Policies sold to a sick pensioner with forged signature of his daughter

    Dear Sir,

    This is to lodge an official complaint against the forgery committed by Reliance Life Insurance's agent A B capital (20879724, Kolkata).
    They have sold the following Reliance Life Insurance policies to my retired and pensioner father Dr Amitabha Chakraborty (Reliance client ID 77415274) -

    17939087 , 50527237 , 50586127 , 50693867 , 50820385 , 50953039

    For all these policies the person whose life is assured is me (Mrs Ujjaini Mukherjee). In all the submitted applications, my signature was forged by the agents who sold the policies by hook and crook. I was not present in India during those days when my signature was forged. My passport has all the entry and exit dates as proof of that. In the application for policy 50527237, in the field 22, my name is given as "UJJAINI DASGUPTA" and it was signed as Ujjaini Mukherjee.

    My father is bed-ridden for quite some time, and he is quite sick, can not walk, he is not able to remember everything. He lives in Kolkata under care of a whole-timer. In last two years he was hospitalized twice. His total income in year through pension is approximately Rs 216000 (around Rs18000/month), he has a whole-timer, a cook, and a maid, also he has to pay for his medicine and hospital, doctor visits. He is NEITHER eligible NOR capable to pay total premium of approximately Rs 190000.

    1)
    I wonder, on what basis Reliance Life Insurance sold these policies to him ? He does not have enough income to sustain these policies. Why RLI did not verify income for the eligibility ?

    2)
    Who forged my signatures ? Why Reliance Life did not verify the submission with proper care ?

    I want immediate investigation on these policy applications, and want quick refund and suspension of these policies.

    Thanks,
    Ujjaini Mukherjee

  5. #5
    Unregistered Guest

    Default Policy no 769700345 shiksha plus of max life insurance

    Dear sir,

    I have purchased policy no 769700345 SHIKSHA PLUS OF MAX LIFE INSURANCE Aliganj branch Lucknow in the month of July 2010 at the premium of Rs 12500/- halfyearly thru its advisor Ms. Pooja Srivastava and her senior Mr. Vineet.

    I was continiously presurrised from the advisor for purchase of the policy as she was in urgent need of confirmation of her services with the company. Being humanbeing I agreed the request and purchased the policy.

    I deposited my 3 premiums amounting to Rs 37500/- in 18 months. After that I approached the advisor thru mobile but there was no reply and all of a sudden I got response from the office that she has resigned from the company. Even there was no confirmation from the office for her resignation.

    At the beginning of the policy I was not informed about the locking period but going thru the documents I found that it can be surrendered after 3 years. I waited for this time and thereafter approached the Aliganj branch office from there I got response that this amount cannot be payable as it is lapsed policy.

    Sir, this has brought me the agony of being cheated and felt getting emotionally blackmailed intially at the time of purchase. Sir, I would request your goodself to kindly arrange to look into for getting back my hardearned money for which I shall be grateful.

    REGARDS,

    RAJENDRA SINGH KHATI
    S 158 SHAKTI NAGAR
    FAIZABAD ROAD
    LUCKNOW
    MOB NO 9452756204
    Email : rs_khati@yahoo.co.in

  6. #6
    Unregistered Guest

    Default Issues with SBI General Insurance.

    I have a Volkswagen Vento Highline 2011 renewed with SBI General Insurance in January, 2013.

    My car was damaged in February, 2013 and i registered the claim for it in September, 2013. I paid a premium for one year and therefore any damages caused to my car after the renewal of my insurance is supposed to be covered under the policy. I have been denied claim just because i did not register a claim earlier. Also, a survey is conducted at the beginning of the one year tenure in which photographs of the current condition of the car is taken. Any damage caused to the car there after is supposed to be covered under the policy regardless of the date on which the claims are made.

    This is pure injustice as i have paid a premium for a whole year and if my car is not covered up for damages during that tenure then the whole purpose of insuring my car is defeated.

  7. #7
    Narenda joshi Guest

    Default rong selling for cold calling

    Quote Originally Posted by admin View Post
    INSURANCE OMBUDSMAN

    The institution of Insurance Ombudsman was created by the Government of India vide its notification dated 11th November, 1998 to handle complaints of aggrieved insured persons. Claimants who could not get their complaints redressed by insurers may get in touch with the Ombudsman relevant to their states.
    advisor code002469,,,,,,,,,,,,,,,,branch name 000................es branch ke ek advisor jiska naam vishal malhotra hai usne mujhe rong policy sell kiya hai mujhe usko panish karna hai mujhe mera paisa wapis diya jaaye n jada tarm ki wo policy sell ki hai rong way se n mai eske liye pahale bhi comlpant kar chuka hu but kisi ne kuch nai kya plz help me naooo werna mai cort case karuga abb aapki company ke khilaf plz meri problam solw ki jaaye .................................................. .................................................. .................................................. .................................................. .................................................. ........................................ NARENDRA JOSHI...............

  8. #8
    s.tandan@yahoo.com Guest

    Post my had been completed last 03 premium yeasr so please my fund value cheque send my estt. address

    my dear sir,

    Sir i was taken icici health sum assured policy no. 14042591 from 16th june 2010 and paid 05 premium @ 10000/- half yearly so paid 50,000/- but at present i am unable next premium. So i want my policy surrender, please my last policy value cheque sent following address.


    Rly. Qtr. 89/01, Station ward railway colony Bhatapara
    P.O. Bhatapara, Dist- ba@@@@bazar C.G -493118

  9. #9
    Unregistered Guest

    Default Against pushpa honda with insurance policy charge more than bill

    dear sir/ madam
    on 09 oct 2013 i have done 2 wheelers insurance (icici lombard) by Pushpa Honda in mansarovar and insurance bill is 949 INR but by dealer give me cash recived of 950 INR and when i come again to receive my 1 INR he gave me warrning that i will cancelled you insurance if u want 1 INR from me.............
    so by this mis beheave in came down in deppresion so i need help and supprot by consumer court for this...................

    Insurance polcy no- 3005/2010695397/B/0000006570
    cash recipt no - 3819

  10. #10
    Unregistered Guest

    Default Against pushpa honda with insurance policy charge more than bill

    dear sir/ madam
    on 09 oct 2013 i have done 2 wheelers insurance (icici lombard) by Pushpa Honda in mansarovar and insurance bill is 949 INR but by dealer give me cash recived of 950 INR and when i come again to receive my 1 INR he gave me warrning that i will cancelled you insurance if u want 1 INR from me.............
    so by this mis beheave in came down in deppresion so i need help and supprot by consumer court for this...................

    Insurance polcy no- 3005/2010695397/B/0000006570
    cash recipt no - 3819

  11. #11
    Chiragdevani12345 Guest

    Angry Extreame delay in the return of repaired Product

    Respected sir,
    Despite of my several visits to Samsung service center-Prayag Services,Pune 411007, I have yet not received my mobile phone which i gave for repair on 25/09/13 (Bill NO.-4160188482) and I was told that I would be receiving the same in the very next visit.But i have yet not got it.It is an example of utter poor servicing quality which is not expected from a company like Samsung.I request you to speed up the delivery process and deliver my mobile phone as soon as possible


    Chirag Devani
    8482823139

  12. #12
    Unregistered Guest

    Default Unsatisfactory service by Bajaj Allianz Costomer care

    this is in reference to my call to Bajaj Allianz Customer Care no. 18001037272. This number does not work. four I was told that my estimated waiting time is three minutes and the process continued and again and again my call was delayed for 3 miutes. I dialed from the number 9007152532 at 19:05 on October 29, 2013 from faizabad Uttar pradesh, finally my call got disconnected at 19:20.

    I request that the customer care service should behave in a responsible manner and provide the correct estimated time so that the valuable time of the customer may be saved.

  13. #13
    Unregistered Guest

    Default all the deduction during the last 5 years

    i have taken several policy of bajaj allianz lic ltd , i have surendered few of them in whichi have doubt of coruption in policy fund value, because when the market is rising my money is increasing little bit but when market crases there is diference of thosand of rupees, can i go for rti, or how can i get the data of of my policy record fund value,.plz help, email-pradipdevdaskr.kumar@gmail.com

  14. #14
    Unregistered Guest

    Default missale of life policies

    The hdfc life insurance company's broker sold me missold 4 policies instead of one policy so i contacted to their branch but couldn't get proper response relating it. i had complained it 3 times always they denied.what shall i do because policies are in laps position.

  15. #15
    Bhupesh bansal Guest

    Post Complaint about reliance services

    Dear Reliance Team,

    I want to put a complaint against your surveyor aligned with A-1 motors Hyundai Workshop,Ballabhgarh. My hyundai car with below details:

    Model : Hyundai Santro GLS
    Registration Number : HR29 W 1400
    Year : 2009
    Owner : Devender Bansal(My Father)
    Contact Number : 08285753716
    Insurance Policy : 1303532311007548
    Surveyor Name : Mr. Avinash Malhotra
    Surveyor Contact No : 7503123023

    I met with an accident 31 Oct 2013, in which my Car's bumper ,left side gate and back light got damaged due to a collision with a Rickshaw driving on wrong way while I was taking a left turn in a street .While turning left and trying to minimize the collision with rickshaw, left side door of the car got bumped into the street light.

    I gave my car for repair under insurance claim(Reliance) to A-1 motors Hyundai Workshop , Ballabgarh,Faridabad on Tuesday, 6th Nov 2013. There was no update from the surveyor regarding my claim however I called up continously for three days(8th,9th,10 Nov) only to know that the surveyor has not given the response. He is Making me Fool from last one week i.e. “It’s in Process”

    Now, when I called up the surveyor today morning to enquire about the status, I got to know that my bumper will not get repaired even when it is very much covered under insurance just like the backlight and left side.When I asked the surveyor on phone for the reason then He said "Ye sab mujhe nhi pata , iska nahi mil sakta aapko kuch claim, aapko karna hai to apne aap karo jaise marzi."( I dont know these things, you can't get this claim. You manage this yourself, I dont know)

    As a loyal customer of Reliance since three years, I request you to please intervene in this and get this resolved for me.

    Thanks,
    Bhupesh Bansal
    08285753716
    Ballabgarh,Faridabad
    121004

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