Prepared By:

Biswajit Chakraborty
Roll No. – 08fc017
IMIS, Bhubaneswar
Introduction
 A quasi – judicial authority.

 A national service which assists in resolving disputes

between insured and insurers.

 Currently 12 OMBUDSMAN offices in the country.

Features
 Complaints upto Rs.20 lakhs can be filed with the
OMBUDSMAN.

 Scheme for only individual beneficiaries and not corporate

entities.

 The case should not be pending before any other forum

Filing a complaint
 Should be written

 Should be filed within a year of rejection by insurer

 First claims should be taken to internal grievance system of

the insurer company.

 Should be filed against the OMBUDSMAN who has

jurisdiction over the region
Characteristics of IOS
 Resolves disputes between consumers and participating
companies

 Free service

 Decisions by IOS are only binding to participating companies

and not consumers.
Powers of OMBUDSMAN
Empowered to consider following complaints:

 Partial/Total repudiation of claim by insurer

 Dispute with regard to premium paid or payable in terms of

policy

 Delay in settlement of claims

 Non – issuance of any insurance documents to customers

after receipt of premium
Appointment of OMBUDSMAN
 Govt. bodies of insurance council issue order of appoinment
.

 Recommended by chairman IRDA, chairman LIC, chairman

GIC, representative of central govt.

 OMBUDSMAN are drawn from Insurance industry, civil

services, judicial services.

 Appointed for 3 yrs or till the incumbant attains 65 yrs,

whichever is earlier.

 No re-appointment .
End