IOR Section 14 : Manner in which complaint to be made

Explanation using Example

Example 1: Filing a Complaint with the Insurance Ombudsman

Introduction: John, a resident of Mumbai, purchased a health insurance policy from XYZ Insurance Company. After a medical procedure, he submitted a claim for reimbursement, which was rejected by the insurer. Feeling aggrieved, John decides to approach the Insurance Ombudsman.

Application: According to Section 14(1) of The Insurance Ombudsman Rules, 2017, John can file a complaint with the Insurance Ombudsman within whose jurisdiction the office of XYZ Insurance Company or his residence is located. He must ensure that his complaint is in writing, as per Section 14(2), and includes his name, address, the insurer's details, facts of the case, and the relief sought.

Outcome: John first needs to make a written representation to XYZ Insurance, as per Section 14(3)(a). If XYZ Insurance rejects his complaint, fails to respond within a month, or provides an unsatisfactory reply, John can proceed to file his complaint with the Ombudsman. He must do this within one year of receiving the insurer's decision or after the one-month period lapses, as outlined in Section 14(3)(b).

Conclusion: By following these steps, John ensures his complaint is valid and can be addressed by the Ombudsman. Non-compliance with these procedural requirements could result in his complaint being di...

Login to access all pages and read more content.

To disable ads and read rest of the premium content, subscribe to KanoonGPT Pro.