Introduction

Dealing with insurance claim issues—whether it’s a delay, denial, or partial settlement—can be a frustrating and confusing experience. It often feels like you're up against a powerful system with no clear path forward. But there’s good news: policyholders in India have access to a dedicated, independent authority that can help. This is where the Insurance Ombudsman steps in—a government-appointed body designed to protect your rights and resolve insurance disputes without the need for lengthy legal battles.

At Claim Nidan, we believe that being informed is the first step to securing fair treatment. In this blog, we’ll explain who the Insurance Ombudsman is, when and how you can approach them, and how we can support you through the process.

Who is the Insurance Ombudsman?
The Insurance Ombudsman is an independent authority appointed by the Government of India under the Redressal of Public Grievances Rules, 1998 (revised in 2017). Their role is to provide speedy, cost-free, and impartial resolution to disputes between insurance companies and their customers.

The Ombudsman operates under the Council for Insurance Ombudsmen and handles complaints related to:

Life Insurance

Health Insurance

General Insurance (for personal use)

When Can You Approach the Insurance Ombudsman?
You can file a complaint with the Insurance Ombudsman if:

Your insurance claim has been unreasonably delayed, denied, or underpaid.

The terms and conditions were misrepresented at the time of policy issuance.

There is a dispute regarding premium payment or policy issuance.

You did not receive a response from your insurer within 30 days of raising a complaint.

Important: Before approaching the Ombudsman, you must first file a written complaint with your insurer. If the insurer does not respond within 30 days or if you are not satisfied with their reply, you can escalate the matter to the Ombudsman.

Benefits of Approaching the Insurance Ombudsman
Free of Cost: No fees or charges for filing a complaint.

Quick Resolution: Most cases are resolved within 90 days.

No Legal Formalities: The process is simple and doesn’t require a lawyer.

 Fair and Impartial: The Ombudsman acts independently and ensures justice.

How to File a Complaint with the Insurance Ombudsman
Here’s a simple step-by-step process:

File a Written Complaint with your insurer and wait for 30 days.

Prepare Your Case: Gather important documents—policy copy, claim form, insurer correspondence, etc.

Lodge a Complaint:

Fill out the Ombudsman complaint form or draft a written complaint.

Send it via email or post to the Ombudsman office that covers your region.

Attend a Hearing (if required): The Ombudsman may call both parties for a hearing to understand the case better.

Receive a Decision: If the decision is in your favor, the insurance company must act on it within 30 days.

Limitations to Keep in Mind
The compensation amount cannot exceed ₹30 lakh.

Only personal insurance complaints are accepted (not commercial or business insurance).

The complaint must be filed within one year of the insurer’s final response or 30 days of no response.

How Claim Nidan Can Help You
At Claim Nidan, we specialize in supporting policyholders through every stage of the claims and dispute process. Whether you’re facing a denied, delayed, or partially settled claim, our team helps you:

Understand your policy rights

Draft strong, well-documented complaints

Communicate effectively with the insurer

Escalate the matter to the Insurance Ombudsman if necessary

With our guidance, you don’t have to navigate the process alone.

Conclusion

Insurance claim disputes can be overwhelming, but you’re not powerless. The Insurance Ombudsman offers a free, fast, and fair way to resolve your grievances. By understanding your rights and the steps involved, you can take control of your situation and seek justice confidently.

At Claim Nidan, we’re here to make sure you don’t face the system alone. Our experts are ready to support you every step of the way.

Need help with your insurance claim? Contact Claim Nidan today for expert assistance!