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BFSI Chronicle, 11 Edition September 2022
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INSURANCE

OMBUDSMAN

RULES, 2017

1. The Insurance Ombudsman Rules have been notified on
th
25 April 2017. These rules shall apply to all insurers and
their agents and intermediaries in respect of complaints
of all personal lines of insurance, group insurance
policies, policies issued to sole proprietorship and micro
enterprises.

2. Rule 13 deals with the Duties and Functions of the
Insurance Ombudsman. The said Rule reads:

“Duties and functions of Insurance Ombudsman:

(1) The Ombudsman shall receive and consider
complaints or disputes relating to—

(a) delay in settlement of claims, beyond the time
specified in the regulations, framed under the
Insurance Regulatory and Development Authority
of India Act, 1999;

(b) any partial or total repudiation of claims by the
life insurer, General insurer or the health insurer;

(c) disputes over premium paid or payable in terms
of insurance policy;

CMA Vadapalli Srinivas (d) misrepresentation of policy terms and conditions at
Former Head- Legal of one of the Leading any time in the policy document or policy contract;
Life Insurance Companies in India
(e) legal construction of insurance policies in so far as

The Institute Of Cost Accountants Of India

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