Page 229 - Ebook health insurance IC27

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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.

Consumer Dispute Redressal forum

Policyholders can approach Consumer Forums for Redressal of complaints. There are
three forums District Forum, State Commission and National Commission.

Jurisdiction of various forums
a. District forum: Value of services and compensation claimed does not exceed 20

lakhs
b. State commission : Value of services and compensation claimed if exceeds Rs.20

lakhs but does not exceed Rs.1 crore
c. National commission : Value of services and compensation claimed if exceeds Rs.1

crore

Appeals
a. Before State commission - Appeal can be made against the order of district forum

within a period of 30 days, Subject to deposit a 50% of the amount awarded or Rs.
25,000 whichever is less
b. Before National commission - Appeal can be made against the order of state
commission within a period of 30 days, Subject to deposit a 50% of the amount
awarded or Rs. 35,000 whichever is less

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