How to file an Insurance Ombudsman complaint
The Insurance Ombudsman is a free forum set up under the Insurance Ombudsman Rules, 2017 for policyholders whose claim was rejected, delayed or short-paid. Write to the insurer first; if it rejects you, does not reply within one month, or replies unsatisfactorily, you can complain to the Ombudsman within one year. No lawyer and no fee are needed, compensation can be up to ₹50 lakh, an award is passed within three months of the complaint being complete, and the insurer must comply within 30 days.
Step by step
Write to the insurer first
Send a written representation to the insurer's grievance officer answering the rejection ground, with your documents. Keep the acknowledgement or complaint number. The Ombudsman will not hear a complaint the insurer has not first had a chance to resolve.
Wait for the reply — or one month
You can approach the Ombudsman if the insurer rejects your representation, does not reply within one month, or replies in a way you are not satisfied with.
Check you are within one year
File within one year of the insurer's rejection or reply (or within one year after the one-month no-reply period). The Ombudsman can condone a delay for recorded reasons, but do not rely on it.
Find the right office
File with the Ombudsman whose area covers the insurer's branch that dealt with you, or the place where you live. There are Ombudsman offices across India.
Prepare the complaint
State your name and address, the insurer and branch, the policy and claim numbers, the facts in order, the loss you suffered and the relief you want. Attach the policy, the rejection letter, your representation and the insurer's reply, and the medical and billing documents.
File online or by post
Complaints can be filed online through the Council for Insurance Ombudsmen portal or Bima Bharosa, or sent on paper to the Ombudsman office. There is no fee.
Attend the hearing
The Ombudsman may first try mediation; if both sides agree, a recommendation follows within one month. Otherwise a hearing is held (in person or online) and an award is passed within three months of receiving all requirements.
The insurer pays
The award binds the insurer, which must comply within 30 days of receiving it and report compliance to the Ombudsman.
What the Ombudsman can decide
- Full or partial rejection of a claim
- Delay in settling a claim
- Disputes over premium paid or payable
- Misrepresentation of policy terms
- Disputes over the interpretation of the policy wording
- Policy servicing complaints, and policies that do not match the proposal
When the Ombudsman cannot help
If the same matter is already pending before, or has been decided by, a court, a consumer commission or an arbitrator. If the compensation claimed is above ₹50 lakh. If you have not first written to the insurer. In those cases the consumer commission is usually the route.
Documents that win Ombudsman complaints
- Policy schedule and wording, including the exclusion list
- The proposal form you signed
- Rejection letter and all correspondence with the insurer and TPA
- Treating doctor's certificate on the date of first diagnosis and why admission was needed
- Discharge summary, investigation reports, prescriptions and final bills
- Renewal history — to prove continuous cover for the moratorium and waiting periods
Get help with your Ombudsman complaint
Medilock prepares the representation and the Ombudsman complaint, attends the hearing with you and follows the award through to payment. Legal fees are 15% + GST of what is actually settled and received by you — nothing if the claim is finally rejected.
Related guides
- Claim rejected? What to do
- IRDAI complaint (Bima Bharosa)
- Consumer court for a rejected claim
- Legal help for a rejected claim
- All rejected-claim guides
Is there a fee to complain to the Insurance Ombudsman?
No. Filing a complaint with the Insurance Ombudsman is free, and you do not need a lawyer.
What is the maximum amount the Insurance Ombudsman can award?
Compensation up to ₹50 lakh, including relevant expenses. Above that, the consumer commission or a civil court is the route.
How long do I have to file an Ombudsman complaint?
Within one year of the insurer's rejection or final reply, or within one year after the insurer fails to reply for one month. You must have written to the insurer first.
How long does the Insurance Ombudsman take?
The Ombudsman passes an award within three months of receiving all the requirements from the complainant. If both sides agree to mediation, a recommendation is made within one month.
Is the Ombudsman's award binding on the insurance company?
Yes. The insurer must comply within 30 days of receiving the award and inform the Ombudsman.
Can I go to the Ombudsman and consumer court at the same time?
No. The Ombudsman will not hear a complaint on a matter that is pending before, or decided by, a court, consumer commission or arbitrator.