IOR Section 4 : Definitions
Act
Summary
Section 4 of the Insurance Ombudsman Rules, 2017 provides essential definitions crucial for understanding the act. Key terms defined include "award," referring to decisions made by the Insurance Ombudsman, and "financial year," which spans from April 1 to March 31. It also clarifies roles such as the "Insurance Ombudsman" and entities like the "Insurance Council." These definitions ensure clarity and consistency in the application of the rules.
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Explanation using Example
Example 1: Understanding the Role of the Insurance Ombudsman
Introduction: Sarah, a policyholder, has a dispute with her insurance company regarding a claim rejection for her health insurance policy. She believes the rejection was unjust and seeks a resolution.
Application: According to Rule 4(e) and 4(g) of The Insurance Ombudsman Rules, 2017, an "Insurance Ombudsman" or "Ombudsman" is appointed to address such grievances. Sarah can approach the Insurance Ombudsman appointed under Rule 7 to seek an "award" as defined in Rule 4(a), which is a decision made by the Ombudsman regarding her complaint.
Outcome: If the Ombudsman finds merit in Sarah's complaint, they may pass an award in her favor, directing the insurance company to settle the claim. Non-compliance by the insurance company could lead to further legal action as per the rules governing the Ombudsman's awards.
Conclusion: By utilizing the services of the Insurance Ombudsman, Sarah can potentially resolve her dispute without resorting to lengthy court proceedings, highlighting the importance of this provision in providing accessible dispute resolution.
Example 2: Group Insurance and the Role of the Insurance Council
Introduction: A comp...
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