The Term-_ ‘Ombudsman’

The term "Ombudsman" comes from Swedish word "Omboodz-man" meaning "a grievance man or person", which the Oxford Dictionary refers to as the " people's defender".

In most democratic countries, there are Ombudsman institutions that are responsible organizations that make the government accountable to the people. Broadly these institutions function to prevent the misuse or abuse of the vast executive power of government by undertaking impartial investigations into governmental activities against its citizens.

Description: Insurance Ombudsman institutions have some limitations in the types of complaints it can encourage. 

Role of Ombudsman In Insurance Sector

The following are some of the examples of the types of complaints for which Insurance Ombudsmen may be approached:

• Any partial or total repudiation of claims by an insurer. 

• Any dispute in regard to premium paid or payable in terms of the policy. 

• Any dispute on the legal construction of the policies in relation to the claims. 

• Delay in settlement of claims. 

• Non-issue of any insurance document to customers after receipt of premium.

There are some limitations in the types of complaints that are usually encouraged by Ombudsmen. The decision of the ombudsman is binding on the insurance companies but not on the insured persons, who may approach the courts, if dissatisfied.

There is also a governing body for Ombudsmen called the Governing Body of Insurance Council (GBIC), which has been set-up under the Redressal of Public Grievances Rules 1998, to look after the functioning of Insurance Ombudsman established all over India (URL: http://ombudsmanindia.org)

GBIC consists of a representative, usually a Chairman or a Managing Director from each of the insurance companies and one or more persons as Insurance 
Address of Governing Body of Insurance Council (GIBC):
Office of Governing Body of Insurance Council,
3rd Floor, Jeevan Seva Annexe, (Above MTNL),
S. V. Road, Santacruz (W),
Mumbai - 400 054.

The Ombudsmen Offices in India

Ahmedabad
Bhopal
Bhubaneshwar
Chandigarh
Chennai
Delhi
Guwahati
Hyderabad
Kochi
Kolkata
Lucknow
Mumbai

AHMEDABAD
2nd Floor, Ambica House
Near C.U. Shah College
5, Navyug Colony
Ashram Road
Ahmedabad - 380 014
Telephone:- 079-27546150, 27546139
Fax:- 079-27546142
E-Mail:- insombahd@rediffmail.com
Area:- Gujarat, UT of Dadra & Nagar Haveli, Daman and Diu. 

BHOPAL
1st Floor, 117, Zone-II (Above D.M. Motors Pvt. Ltd.)
Maharana Pratap Nagar
Bhopal - 462 011
Telephone:- 0755-2769200, 2769201
Fax:- 0755-2769203
E-Mail:- bimalokpalbhopal@airtelbroadband.in
Area:- Madhya Pradesh and Chhattisgarh.

BHUBANESHWAR
62, Forest Park
Bhubaneshwar - 751 009
Telephone:- 0674-2535220, 2533798
Fax:- 0674-2531607
E-Mail:- ioobbsr@vsnl.net
Area:- Orissa. 

CHANDIGARH
S.C.O. No. 101, 102 & 103, 2nd Floor,
Batra Building, Sector - 17-D
Chandigarh - 160 017
Telephone:- 0172-2706196, 2705861
Fax:- 0172-2708274
E-Mail:- ombchd@yahoo.co.in
Area:- Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir, Union Territory of Chandigarh.

CHENNAI
Fatima Akhtar Court, 4th Floor
453 (Old No. 312), Anna Salai
Teynampet
Chennai - 600 018
Telephone:- 044-24333678, 24333668
Fax:- 044-24333664
E-Mail:- insombud@md4.vsnl.net.in
Area:- Tamil Nadu, Pondicherry Town and Karaikal (Which are parts of the UT of Pondicherry). 

DELHI
2/2 A, 1st Floor, Universal Insurance Building
Asaf Ali Road
New Delhi - 110 002.
Telephone:- 011-23239611, 23237539, 23237532
Fax:- 011-23230858
E-Mail:- iobdelraj@rediffmail.com
Area:- Delhi and Rajasthan.

GUWAHATI
Aquarius
Bhaskar Nagar
R.G. Baruah Road
Guwahati - 781 021
Telephone:- 0361-2413525
Fax:- 0361-2414051
Area:- Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura.

HYDERABAD
6-2-46, 1st Floor, Main Court
Lane Opp. Saleem Function Palace
A.C. Guards, Lakdi-Ka-Pool
Hyderabad - 500 004
Telephone:- 040-65574325, 65504122
Fax:- 040-23376599
E-Mail:- hyd2_insombud@sancharnet.in
Area:- Andhra Pradesh, Karnataka and Yanam (Part of UT of Pondicherry). 

KOCHI
2nd Floor, CC 27/2603, Pulinat Building
Opp. Cochin Shipyard
M.G. Road
Ernakulam - 682 015
Telephone:- 0484-2358734, 2359338
Fax:- 0484-2359336
E-Mail:- ombudsmankochi@yahoo.co.in
Area:- Kerala, UTof Lakshadweep, UTof Mahe (a part of the UT of Pondicherry).

KOLKATA
North British Building
29, N.S. Road, 3rd Floor
Kolkata - 700 001
Telephone:- 033-22134869, 22134867
Fax:- 033-22134868
E-Mail:- iombkol@vsnl.net
Area:- West Bengal, Bihar, Jharkhand, Sikkim and UT of Andaman & Nicobar Islands.

LUCKNOW
Jeevan Bhawan
Phase - 2, 6th Floor
Nawal Kishore Road
Hazartganj
Lucknow - 226 001
Telephone:- 0522-2201188, 2231330
Fax:- 0522-2231310
E-Mail:- ioblko@sancharnet.in
Area:- Uttar Pradesh and Uttaranchal. 

MUMBAI
3rd Floor, Jeevan Seva Annexe
S.V. Road
Santa Cruz (West)
Mumbai - 400 054.
Telephone:- 022-26106928, 26106360
Fax:- 022-26106052
E-Mail:- ombudsman@vsnl.net
Area:- Maharashtra and Goa.


Insurance Companies

List of insurance companies and their web-addresses are enclosed for ready reference

• Life Insurance Corporation of India (LIC) 

• The New India Assurance Co. Ltd. 

• The National Insurance Co. Ltd. 

• The United India Insurance Co. Ltd. 

• The Oriental Insurance Co. Ltd. 

• The G.I.C. of India 

• SBI Life Insurance Co. Ltd. 

• Tata AIG Life Insurance Co. Ltd. 

• ICICI Prudential Life Insurance Co. Ltd. 

• HDFC Standard Life Insurance Co. Ltd. 

• Tata AIG General Insurance Co. Ltd. 

• Royal Sundaram Alliance Insurance Co. Ltd. 

• Reliance General Insurance Co. Ltd. 

• IFFCO - TOKIO General Insurance Co. Ltd. 

• Birla Sunlife Insurance Co. Ltd. 

• Max New York Life Insurance Co. Ltd. 

• Kotak Mahindra Old Mutual Life Insurance Ltd. 

• Bajaj Allianz General Insurance Co. Ltd. 

• Bajaj Allianz Life Insurance Co. Ltd. 

• AMP Sanmar Life Insurance Co. Ltd. 

• ING Vysya Life Insurance Co. Ltd. 

• Metlife India Insurance Co. Pvt. Ltd. 

• Aviva Life Insurance Co. India Pvt. Ltd. 

• HDFC-Chubb General Insurance Co. Ltd. 

• Cholamandalam General Insurance Co. Ltd. 

• Agriculture Insurance Co. of India Ltd. 

• Export Credit & Guarantee Corporation of India 

• ICICI Lombard General Insurance Co. Ltd. 

• Sahara India Life Insurance Co. Ltd 
  

FAQs 

1) Who can approach the Ombudsman?
Any individual who has taken an Insurance Policy or, the legal heirs under such policy, can approach Ombudsman

2) Can we approach the Ombudsman with complaints that have been already launched in a Forum / court on the same subject?
No. Any complaint on the same subject matter, which is already before a Court / Consumer Forum, cannot be submitted to the Ombudsman.

3) Is there any formal procedure for lodging a complaint with the Ombudsman?
Yes. The Procedure is very simple. The complaint can be written in a plain paper and be submitted. If the complaint falls within the terms of reference, the forum will issue specific forms to the complainant.

4) Is there any fees / charges payable to the Ombudsman for lodging a complaint?
No. There is no fees/charges that need to be paid to lodge a complaint.

5) Is there any time limit to approach the Ombudsman?
Yes. One year from the date of rejection by the insurer or from receiving the Insurer's final reply to the complainant's representation.

6) Is there any maximum limit for the amount under dispute that can be entertained by the Ombudsman?
Yes. The maximum limit for the amount under dispute is Rs. 20 lakhs.

MINISTRY OF FINANCE

(Insurance Division, Department of Economic Affairs) New Delhi
NOTIFICATION
11th November 1998

G. S. R. 670(E). – In exercise of the powers conferred by sub-section (1) of Section 114 of the Insurance Act, 1938 (4 of 1938) the Central Government hereby frames the following Rules: -

1. Short title - These Rules may be called the Redressal of Public Grievances Rules, 1998.

2. Application - These Rules shall apply to all the insurance companies operating in general insurance business and in life insurance business.
The Central Government may exempt an insurance company from the provisions of these Rules, if it is satisfied that an insurance company already has grievance redressal machinery, which fulfills the requirements of these Rules.

3. The objectives of these Rules are to resolve all complaints relating to settlement of claim by insurance companies in a cost effective, efficient and impartial manner.

4. Definition - In these rules unless the context otherwise requires:-
(a) “Act” means, Insurance Act, 1938.

(b) “Committee” means, an advisory committee referred to in Rule 19.

(c) “Financial year” means, period of twelve months commencing from the 1st day of April of a year and ending on 31st day of March of the succeeding year.

(d) “General Insurance Corporation of India” means, a government company formed under sub-section (1) of section 9 of the General Insurance Business (Nationalisation) Act, 1972 and shall include a subsidiary company of such company

(e) “Governing body” means, governing body of the Insurance Council constituted under sub-rule (1) of rule 5.
(f) “Insurance Council” means, the Life Insurance Council and the General Insurance Council referred to in section 64C of the Act.

(g) “Insurance Regulatory Authority” means, a body established by Government of India vide Resolution No. 17(2) / 94 Ins. V, dated 23-01-1996, to monitor the orderly growth of insurance industry.

(h) “Insurance Company” means, the Life Insurance Corporation of India, the General Insurance Corporation of India and any other company, which has been given a license to carry on business of life insurance or of the general insurance, as the case may be.

(i) “Insured person” means, an individual by whom or on whose behalf an insurance policy has been taken on personal lines.

(j) “Life Insurance Corporation of India” means, the Life Insurance Corporation of India established under the Life Insurance Corporation Act, 1956.

(k) “Personal lines’ means, an insurance policy taken or given in an individual capacity.

5. Governing body of Insurance Council -
(1) There shall be a Governing Body of the Insurance Council which will consist of one representative from each of the insurance companies.

(2) The representatives of an insurance company shall ordinarily be a Chairman or a Managing Director or any one of the Directors of such company.

(3) The Governing body shall formulate its own procedure for conducting its business, including the election of the Chairman.
Provided that the Chairman of the Life Insurance Corporation of India shall act as the first Chairman of the governing body.

6. Ombudsman –
A. The governing body shall appoint one or more persons as ombudsman for the purpose of these rules.
B. The Ombudsman selected may be drawn from a wider circle including those who have experience or have been exposed to the industry, civil service, administrative service, etc. in addition to those drawn from judicial service.
C. An Ombudsman shall be appointed by the Governing Body from a panel prepared by the Committee consisting of –
(i) Chairman of Insurance Regulatory Authority - Chairman.
(ii) Two representatives of Insurance Council including one from the Life Insurance Business and another from the General Insurance Business - Member.
(iii) One representative of the Central Government - Member.

7. Term of Office – An Ombudsman shall be appointed for a term of three years and shall be eligible for re-appointment. Provided that no person shall hold office as Ombudsman after he has attained the age of 65 years. (According to the amendment Dt. 21.6.99, provision of reappointment has been cancelled).

8. Removal from Office. –
(i) An Ombudsman may be removed from service for gross misconduct committed by him during his term of office.
(ii) The Governing Body may appoint such person as it thinks fit to conduct enquiry in relation to misconduct of the Ombudsman.
(iii) All enquiries on misconduct will be sent to Insurance Regulatory Authority which may take a decision as to the proposed action to be taken against the Ombudsman.
(iv) On recommendations of the Insurance Regulatory Authority if the Governing Body is of opinion that the Ombudsman is guilty of misconduct, it may terminate his services.

9. Remuneration of Ombudsman –
(i) There shall be paid to Ombudsman a salary which is equal to the salary of the Judge of a High Court. (This has been changed as per amendment dt. 21.6.99)
(ii) The other allowances and perquisites of the Ombudsman shall be such as may be specified by the Central Government.

10. Territorial Jurisdiction of Ombudsman –
(1) The office of the Ombudsman shall be located at such place as may be specified by the Insurance Council from time to time.
(2) The Governing Body shall specify the territorial jurisdiction of each Ombudsman.
(3) The Ombudsman may hold Office sitting at various places within his area of jurisdiction in order to expedite disposal of complaints.

11. Staff –
(i) The Ombudsman shall have such secretarial staff as may be provided to him by the insurance Council after having consultation with the Ombudsman.
(ii) The ombudsman may engage the services of professional expert with a view to assist him in discharging his functions.
(iii) The salary, allowances and perquisites payable to Ombudsman,and the salary, allowances and other benefits payable to the staff of the secretariat and all expenses incurred for the purposes of these rules shall be borne by the Insurance council.
(iv) The Ombudsman shall prepare the budget, indicating the requirement of funds, before the beginning of every financial year.
(v) The budget of the office of Ombudsman will be sent to the Governing Body.
(vi) The Governing Body will finalise the budget in consultation with the Ombudsman and shall allocate the funds to the office of Ombudsman.
(vii) The total expenses on Ombudsman and his staff shall be incurred by the insurance companies who are members of the insurance council in such proportion as may be decided by the Governing Body from time to time. Provided that till the Governing Body takes a decision, the entire expenditure shall be shared equally between the insurance companies in the life insurance business and general insurance business in equal proportion.
(viii) The share of expenditure, which is to be incurred by each insurance company, shall be in the ratio of premium income for the previous year of such company.
Explanation - For the purpose of this sub-rule “premium income” means the gross direct premium income of the insurer without taking into account the time to time income on reinsurance accepted by the insurance company.

12. Power of Ombudsman: -
(i) The Ombudsman may receive and consider: -
(a) Complaints under rule 13;
(b) Any partial or total repudiation of claims by an insurer;
(c) Any dispute in regard to premium paid or payable in terms of the policy;
(d) Any dispute on the legal construction of the policies in so far as such disputes relate to claims;
(e) Delay in settlement of claims;
(f) Non-issue of any insurance document to customers after receipt of premium.
(ii ) The Ombudsman shall act as counsellor and mediator in matters which are within his terms of reference and if requested to do so in writing by mutual agreement by the insured person and insurance company.
(iii) The Ombudsman’s decision whether the complaint is fit and proper for being considered by it or not shall be final.

13. Manner in which complaint is to be made :-Mode of Complaint
(1) Any person who has a grievance against an insurer, may himself or through his legal heirs make a complaint in writing to the Ombudsman within whose jurisdiction the branch or office of the insurer, against whom the complaint is made, is located.
(2) The complaint shall be in writing duly signed by the complainant or through his legal heirs and shall state clearly, the name and address of the complainant, the name of the branch or office of the insurer against whom the complaint is made, the fact giving rise to the complaint supported by documents, if any, relied on by the complainant, the nature and extent of the loss caused to the complainant and the relief sought from the Ombudsman.
(3) No complaint to the Ombudsman shall lie unless:-
(i) The complainants had, before making a complaint to the Ombudsman, made a written representation to the insurer named in the complaint and either insurer had rejected the complaint or the complainant had not received any reply within a period of one month after the insurer concerned received his representation or the complainant is not satisfied with the reply given to him by the insurer.
(ii) The complaint is made not later than one year after the insurer had rejected the representation or sent his final reply on the representation of the complainant; and
(iii) The complaint is not on the same subject matter, for which any proceedings before any court, or Consumer Forum, or arbitrators is pending or were so earlier.

14. Ombudsman to act fairly and equitably.
(i) The Ombudsman may, if he deems fit, adopt a procedure other than mentioned in sub-rule (1) and (2) of Rule 13 for dealing with a claim, Provided that the Ombudsman may ask the parties for necessary papers in support of their respective claims and where he considers necessary, he may collect factual information available with the insurance company.
(ii) The Ombudsman shall dispose of a complaint fairly and equitably.

15. Recommendations made by the Ombudsman:
(i) When a complaint is settled, through mediation of the Ombudsman, undertaken by him, in pursuance of request made in writing by complainant and insurer through mutual agreement, the Ombudsman shall make a recommendation which he thinks fair in the circumstances of the case. The copies of the recommendation shall be sent to the complainant and the insurance company concerned. Such recommendation shall be made, not later than one month from the date of the receipt of the complaint.
(ii) If a complainant accepts the recommendation of the Ombudsman, he will send a communication in writing, within 15 days of the date of receipt of the recommendation. He will confirm his acceptance to the Ombudsman and state clearly that the settlement reached is acceptable to him, totally, in terms of recommendations made by the Ombudsman in full and final settlement of the complaint.
(iii) The Ombudsman shall send to the insurance company, a copy of the recommendation along with the acceptance letter received from the complainant. The insurer shall thereupon comply with the terms of the recommendations not later than 15 days of the receipt of such recommendation, and the insurer shall inform the Ombudsman of its compliance.

16. Award:
(i) Where the complaint is not settled by agreement under Rule 15, the Ombudsman shall pass an award which he thinks fair in the facts and circumstances of a claim.
(ii) An award shall be in writing and shall state the amount awarded to the complainant, Provided that Ombudsman shall not award any compensation in excess of what is necessary, to cover the loss suffered by the complainant as a direct consequence of the insured peril, or for an amount not exceeding rupees twenty lakhs (including ex-gratia and other expenses), whichever is lower.
(iii) The Ombudsman shall pass an award within a period of three months from the receipt of the complaint.
(iv) A copy of the award shall be sent to the complainant and the insurer named in the complaint.
(v) The complainant shall furnish to the insurer, within a period of one month from the date of receipt of the award, a letter of acceptance that the award is in full and final settlement of his claim.
(vi) The insurer shall comply with the award within 15 days of the receipt of the acceptance letter under sub-rule (5) and it shall intimate the compliance to the Ombudsman.

17. Consequences of non-acceptance of award: If the complainant does not intimate the acceptance under sub-rule (5) of rule 16, the award may not be implemented by the insurance company.

18. Power to make Ex-gratia payment: If the Ombudsman deems fit, he may award an Ex-gratia payment.

MISCELLANEOUS PROVISIONS:

19. Advisory Committee: An Advisory Committee, consisting of not more than five eminent persons, shall be notified by the Government to assist the Insurance Regulatory Authority to review the performance of the Ombudsman from time to time. The Insurance Regulatory Authority shall decide the time, venue and forum of such meeting. The authority, after discussing the matter with the Governing Body, may recommend to the Government appropriate proposals for effecting improvements in the functioning of the Ombudsman. In the light of recommendations made by the Insurance regulatory Authority, the Government may carry out such amendments to these rules as they may deem fit.

20. The Ombudsman shall furnish a report every year, containing a general review of the activities of the office of the Ombudsman during the preceding financial year, to the Central Government, and such other information as may be considered necessary by it. In the Annual Report, the Ombudsman will make an annual review of the quality of services rendered by the insurer, and make recommendations to improve these services.

21. Recommendation of the Insurance Council: The Insurance Council may suggest to the Ombudsman such recommendation as it deems fit, and which, in its opinion, will enhance the utility of the annual report, and also so that the objectives of the rules are clearly analyzed in terms of the activities for the year under review. The Ombudsman in this report will incorporate suggestions for long-term improvement of the insurance sector.
[F. No. 56/32/97 - Ins.1]
D.C. SRIVASTAVA, 
Director