Page 82 - Insurance Surveyors Book Ebook IC S01

Survey And Loss Assessment IC-S01

The ombudsman are being appointed at important centers of the country and shall

become an important quasi-judicial machinery to help the insurance industry to grow

in a competitive environment. The performance of the ombudsman shall be

reviewed by a committee appointed by the IRDA from time to time. Similarly the

ombudsman shall review through its annual report to IRDA functioning of the

insurers and recommend steps for improvement.

Prerequisites for filing a complaint to an ombudsman

a. Only complaints pertaining to personal lines of insurance

b. The policyholder has not received suitable reply for the representation made

with the insurer for at least one month

c. Complaint must be lodged within one year of the dispute

d. Total relief sought must be within an amount of Rs.20 lakhs

e. Subject matter of complaint should not have been referred to a court/consumer

forum

Ombudsman shall give his recommendation within one month and pass the

award within three months.

The recommendation by insurance ombudsman will be in full and final

settlement of the complaint

If the complainant is not satisfied he may take suitable legal recourse

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