Insurance Ombudsman complaint — format, documents and how to file

You can complain to the Insurance Ombudsman after writing to the insurer first — once the insurer rejects your representation, or after one month with no reply — and within one year of its final reply. Filing is free, online at cioins.co.in or on paper to the Ombudsman office for your area, and the award, up to ₹50 lakh, binds the insurer.

Step by step

  1. Check you can file

    You wrote to the insurer first; it rejected that or did not reply in a month; it is within one year of the final reply; and the same dispute is not before a court or consumer commission.

  2. Choose online or on paper

    Online on the Council for Insurance Ombudsmen portal (cioins.co.in), or a signed complaint posted or emailed to the Ombudsman office that covers your address.

  3. Fill the complaint form

    Your details, the insurer, policy and claim numbers, the amount in dispute, the dates of the claim, rejection and your representation, and the relief you want.

  4. Write the statement of facts

    One page, in date order, ending with why the rejection is wrong and what you ask for (the format is below).

  5. Attach the documents

    Policy, rejection letter, your grievance letter and the insurer's reply, proposal form, doctor's certificate, discharge summary, bills.

  6. Hearing and award

    The office may call both sides to a hearing, often by video. The award comes within three months of a complete complaint, and the insurer must comply within 30 days.

Statement of facts — format

1. I hold [insurer] policy no. [ ] since [date], renewed without a break. 2. [Patient] was admitted to [hospital] on [date] for [illness] and discharged on [date]. 3. The claim of ₹[ ] was rejected on [date] on the ground "[quote]". 4. I wrote to the Grievance Redressal Officer on [date]; the insurer replied on [date] repeating the rejection / did not reply.

5. The rejection is wrong because: [each ground, each answer, the document]. 6. Relief sought: payment of ₹[ ] with interest from [date], and costs.

Documents checklist

Ombudsman or consumer court?

The Ombudsman is free, needs no lawyer and is usually faster; the award binds the insurer but not you. Choose the consumer commission when the claim is above ₹50 lakh, when the one-year limit has passed (you have two years there), or when you want compensation for harassment as well.

Related guides

Is there a fee to file an Insurance Ombudsman complaint?

No. There is no fee and you do not need a lawyer.

What is the time limit to file an Ombudsman complaint?

Within one year of the insurer's final reply to your representation, or within one year after the one month the insurer had to reply.

Can I file an Insurance Ombudsman complaint online?

Yes, on the Council for Insurance Ombudsmen portal, cioins.co.in, and through Bima Bharosa.

What is the maximum the Ombudsman can award?

Up to ₹50 lakh, including expenses.