The Insurance Ombudsman Rules, 2017

The Insurance Ombudsman Rules, 2017 (IOR), established under the IRDA Act, 1999, provide a structured framework for resolving insurance-related grievances. These rules supersede the Redressal of Public Grievances Rules, 1998, ensuring a modern approach to dispute resolution between policyholders and insurers.

Introduction and Objectives (Sections 1–2)

The act begins by establishing its title and commencement, setting the foundation for its implementation. It aims to address complaints related to personal lines of insurance, group policies, and policies for sole proprietorships and micro enterprises. The focus is on cost-effective and impartial resolution, ensuring fair treatment by insurance companies and their agents.

Application and Definitions (Sections 3–4)

The rules apply to all insurers, their agents, and intermediaries, covering a broad range of insurance-related grievances. Key definitions are provided to ensure clarity, including terms like "award" and "financial year," which are crucial for understanding the act's application.

Governance and Administration (Sections 5–12)

The act establishes the Council for Insurance Ombudsmen, detailing its composition and functions. It outlines the selection process for appointing Insurance Ombudsmen, including qualifications and selection criteria. The term of office, remuneration, and territorial jurisdiction of Ombudsmen are also specified, ensuring a well-structured administrative framework.

Complaint Handling and Resolution (Sections 13–17)

The duties and functions of the Insurance Ombudsman include receiving and considering complaints about insurance services. The act specifies the procedure for lodging complaints and mandates fair and equitable handling. It also provides for mediation and the issuance of awards when mediation fails, ensuring comprehensive dispute resolution mechanisms.

Review and Recommendations (Sections 18–20)

The act mandates an annual review of the Ombudsman's activities, with reports submitted to the Council and the Authority. An Advisory Committee is established to review performance, and recommendations can be made to the Central Government to enhance the system's effectiveness.

In conclusion, the Insurance Ombudsman Rules, 2017, play a vital role in maintaining transparency and fairness in the insurance industry, benefiting policyholders by providing a reliable mechanism for grievance redressal.