Page 81 - Insurance Surveyors Book Ebook IC S01

Survey And Loss Assessment IC-S01

internal mechanism to settle such disputes to the satisfaction of Government, it

can be made exempt from the purview of the ombudsman.

The ombudsman is a Swedish word which means the right of the individual to

complaint against the public authority/administration. The ombudsman has a

right to receive the complaints relating to

a) any partial or total repudiation of claim by an insurer,

b) dispute regarding payment of premium,

c) any legal construction of the provisions of the policies relating to claims,

d) delay in settlement of claims,

e) non-issuance of document after receipt of premium.

The complaint can lie with ombudsman only after the complainant has exhausted all

measures to get redressal from the company and his complaint is not pending with

any other judicial body. The complaint has to be made within one year after the

insurer has rejected his representation.

The awards of the ombudsman must be given within three months of filing the

complaint. His recommendation or awards have been made binding on insurer

subject to the acceptance of the complainant, i.e. the insured. In otherwords, if the

complainant is not satisfied with the content of the award, he has a right not to

accept it and is free to approach a court of law. The ombudsman's power to award

compensation is limited to 20 lakhs, as in case of state commission under C P Act.

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