Insurance Ombudsman


 
 
Concept Explanation
 

Insurance Ombudsman

The governing body of the Insurance Council is authorized by law to appoint Ombudsmen for the insurance industry.  The function of the Ombudsman is to resolve complaints in respect of disputes between policyholders and insurers in cost effective, efficient and impartial manner.

The complaints to the Ombudsman may relate to

(a) partial or total repudiation of claims

(b) any dispute regarding premium paid or payable in terms of the policy

(c) any dispute on the legal construction of the policy relating to claims

(d) delay in settlement of claims

(e) non - issue of any insurance document to customers after receipt of premium.

The Ombudsman acts as counsel and mediator in matters within its terms of reference. It is not a judicial authority. It has no right to summon witness. It has to make its decision on the basis of documents submitted to it. The complaint and the insurer are allowed to make personal submissions. But lawyers are not permitted to argue the case.

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