Page 48 - The Insurance Times March 2025

in Mumbai and Goa said the objective is quick resolution of ranked the lowest with only 53 awards in favour of com-
complaints where complainants do not have to bear any plainants versus 612 in favour of the insurer.
expenses. Consumer courts involve legal costs such as advo-
cate fees and stamp duty and it still leads to delayed reso- Ombudsman offices spend an average Rs. 12,000 to process
lution. A case for non-legal assistance Sumit Bohra, presi- a complaint, far lower than what it was. The Insurance
dent, Insurance Brokers Association of India, said at least Ombudsman Council receives funds from insurance compa-
brokers should be allowed to represent their clients. "We nies based on their turnover. Misra suggests the cost of dis-
brought up the matter with the regulator as our clients posing complaints must be recovered directly from insurers
reach out to us when they face issues in claims settlement. against whom the complaint is registered. "It would nudge
If we want to ensure that illegal players do not dupe policy- insurers to resolve complaints at their end and policyhold-
holders, the regulator should recognise a few entities who ers won't have to reach out to the ombudsman in the first
can offer such a support if they seek it," said Bohra. place," said Misra.

There are 17 ombudsman offices in India. In FY24, they re- Ajit Kumar from Kerala faced a different challenge. He filed
solved 49,705 complaints, out of which 16% were in favour a complaint against an online broking firm at the ombuds-
of complainants, 15% in favour of companies, 6% complaints man, but they did not accept it. "They told me that they
were withdrawn, 23% were not entertained and 27% were need a record of my communication with the grievance
mediations, data showed. officer of the broking firm, but it didn't have one. I have mails
from the CEO, but the ombudsman is demanding my com-
"An ombudsman makes fair recommendations to the com- munication record with the grievance officer," he said. To
plainant. If he accepts it, it is forwarded to the insurer for be sure, brokers were included in the ambit of ombudsman
compliance. In such cases, hearings with the complainant recently, but most of them do not have a designated griev-
and insurance company is not needed, so it leads to faster ance officer like insurance companies do.
resolution. It could either be in favour of the complaint or
insurance company or a mid-way out," said Kharat. In FY24, "The ombudsman should entertain Kumar's complaint and
67.40% of the complaints, including awards and mediation, accept a claims denial statement by a claims executive of
favoured complainants. the broker. Irdai must make it mandatory for broking houses
to have a grievance officer to bring symmetry in operation,
Analysis showed Mumbai, Bengaluru and Jaipur were top otherwise decisions will be based on each ombudsman's
states where awards favoured the complainants. Delhi perceptions," said R.M. Singh. (Source: Mint)

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The Insurance Times March 2025 43