Page 228 - Ebook health insurance IC27

The Insurance Times

5. Policyholder may also approach consumer forum for Redressal
6. They may also approach civil courts directly for Grievance Redressal without

approaching Insurance Ombudsman

The Insurance Ombudsman

In pursuance to consumerism, several steps are being taken to protect the consumer.
Consumers' Protection Act 1986 is one such we have considered.

Monopoly and Restrictive Trade Practices Act (MRTP) and Standards and Weight
Measures Act are other legislations towards the same end and now it is the ombudsman
scheme especially designed to protect the insured, wherever he is aggrieved against any
insurer.

The ombudsmen 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

232 Guide for Health Insurance