Insurance Ombudsman Now Accepts Claim Complaints Upto Rs 50 Lakh
As of 10 November 2023, policyholders in India can now file complaints related to compensation claims up to Rs 50 lakh with insurance ombudsman offices, marking an increase from the previous cap of Rs 30 lakh.
The amendment to the insurance ombudsman rules by the finance ministry addresses the evolving needs of policyholders, particularly those investing in high-value insurance covers like term insurance, health insurance, critical insurance and personal accident policies. The change aligns with the growing demand for comprehensive protection, especially as individuals opt for coverage exceeding Rs 1 crore, as indicated by a study from Policybazaar.com.
Shilpa Arora, co-founder of Insurance Samadhan, an insurance grievance redressal platform, highlighted the significance of this enhancement in the compensation cap. The Office of Insurance Ombudsman serves as an alternate grievance redressal platform, swiftly and cost-effectively resolving policyholders' grievances against insurance companies and intermediaries. The offices are under the administrative control of the Council for Insurance Ombudsman (CIO).
If dissatisfied with the insurer's response, policyholders can register grievances on the IRDAI's online portal, the 'Bima Bharosa System,' or file a complaint with the Insurance Ombudsman within a year of rejection by the insurance company. The insurance ombudsman offices handled over 92 per cent of the 55,946 complaints received during the 2022-23 fiscal year.
Policybazaar's data from April 2023 to September 2023 identified reasons for health insurance claim rejections. Incomplete waiting periods, claims outside coverage, wrongly filed claims, exhausted limits and non-disclosure of pre-existing conditions were among the contributing factors. Understanding these rejection categories is crucial for policyholders, emphasising the importance of awareness and transparency in the claims submission process.
