Hyderabad: “I was denied my insurance amount by HDFC Life Insurance when I claimed money for a knee replacement because I had hypertension. When I approached the insurance ombudsman, I got my money,” says Mr Sajjan Kumar Agarwal.
Insurance companies are notorious for not disbursing claims on some pretext or other but there is a mechanism to solve grievances of individual clients free of cost, only not many are aware of it and approach the insurance ombudsman.
In order to educate people about this facility, an awareness week is held every year on November 12, at the LIC building.
The system of having an ombudsman for insurance dates back to 1998. The objective is to provide a forum for resolving disputes and complaints of the aggrieved insured public. There are 17 such centres functioning in different states as of now.
Mr T.C. Susheel Kumar, zonal manager, Life Insurance Corporation (LIC), said the office of ombudsman ensures that "whatever the mistakes done by insurance companies, knowingly or unknowingly, are rectified and the client gets justice.”
Mr I. Suresh Babu, the insurance ombudsman for TS, AP and the Puducherry enclave of Yanam, said, “People are not aware of the existence of the forum. It is the most cost effective way for clients as there is no fee, no advocate or any such formalities. All they need to do is to give a written complaint to the ombudsman on plain paper. After going through everything, we will give the order, in favour of the client if the case deserves it. Even if the client signs the agreement copy and has not understood the conditions because of his lack of education, we will consider all those aspects too and take our decision.”
The ombudsman is supposed to resolve the issue within three months of receipt of the complaint, without payment of any fee. The complaint can be made in writing and sent by mail or delivered personally. However, before approaching the ombudsman, a representation must be made to the grievance redressal officer of the insurance company. If no reply is received within one month, or the given reply is not satisfactory, the insured person can approach the ombudsman with the required documents and expect to get a fair hearing.
The complainant can approach a consumer forum or civil court if not satisfied with the award of the ombudsman. The maximum amount under dispute for which the ombudsman can entertain a complaint is Rs 30 lakh. At times hearings are also conducted outside headquarters in important centres depending upon the number of complaints received from that place.
During 2017-18, out of 888 complaints received, awards were issued in 611 cases amounting to Rs 1.04 crore. During the current financial year 2018-19, till October 31, out of 830 complaints received, awards were issued for 270 cases amounting to Rs 4.96 crore.
