An alternative mode of resolving disputes over insurance claims has helped dispose of 32 per cent more complaints in 2021-22 year-on-year.
While the break-up for 2021-22 is not available, complaints relating to health insurance made up a third of the total number cases disposed of by ombudsmen in 2020-21, a period marked by the first wave of Covid-19.
The Delhi office settled 3,830 complaints in 2021-22, or 9.4 per cent of the all India figure, Sudhir Krishna, Insurance Ombudsman in the region told reporters in New Delhi.
Of this, almost 30 per cent, or 1,129 complaints, related to health insurance, he said.
Bejon Kumar Misra, member of advisory committee, Insurance and Regulatory and Development Authority of India (Irdai) wondered why insurance firms don’t tell consumers they can approach ombudsmen in case disputes arise.
Ombudsmen are an alternative mode of settling insurance disputes, constituted under rules framed by the finance ministry in 2017. The other routes include moving consumer courts, which are time consuming and expensive. No fee is charged for approaching ombudsmen.
However, in order to approach the ombudsman, the complainant must first move the insurer’s grievance cell. If he does not receive a satisfactory resolution within a month, he can approach the ombudsman concerned.
An Ombudsman can resolve the complaints through conciliation or through an award. The award is binding only on the insurance company, not the consumers. This means the consumer can challenge the award in court.
As many as 60 per cent of the complaints resolved by ombudsmen in 2021-22 were through conciliation and the remaining through awards, Krishna said. Eighty-one per cent of the complaints were against private insurers and the rest against LIC and PSU general insurers.