FAQs: Insurance Dispute

What to do – when you have a Dispute with an Insurance Company or Agent?

If you have a dispute with an Insurance Company (i.e. your insurer company) or agent (who insured you), the first thing keep in mind that ‘don’t panic’ rather keep patience.

Besides, there certain following steps that you can take on your own before taking any legal action:

  • The first step – contact an authoritative person of insurance company/management;
  • The second step – explain your problems politely and request to solve your problem;
  • The third step – provide all the details and supporting documents – if required so
  • The fourth step – if insurance company management still not convinced, then ask him to give his response in written. Ask them to provide the guidelines and specific rules that empower them to refuse to solve your dispute.
  • The fifth step – if the management not ready to give its response in written, again don’t be panic; write an email to companies grievances and redressal cell and keep the management (with who you already contacted) and the head management in CC (i.e. carbon copy). Narrate the whole story.
  • The sixth step – Wait for some time, if your problem addressed satisfactorily by the grievances cell – excellent or else if grievances ignored your complaint or illustrated to their inability to solve your problem, then you can file a case in your respective consumer forum.
  • The seventh step – there is one more shelter that you can look for before filing your case into a consumer forum, i.e. “insurance ombudsman.” Though insurance ombudsman is not essentially required before filing you case into a consumer forum, but it also a authorized body that can solve your problem comparatively faster.
  • The eight step – if you still feeling that your insurance dispute did not address properly and you did not get the proper solution, file a case in consumer forum. 

Do I Need to Hire an Advocate to File a Case of Insurance Dispute?

In the simplest and shortest language, the answer is ‘NO.’
You are not at all required to hire an advocate to for any EIGHT steps that discussed above provide you have a little knowledge to present your case/issue in orderly manner as well as you have time to do all these things, as it is time taking process.

Otherwise, to present your case and problems in an influential and orderly manner, you are suggested to take the service of an advocate. 

What is Insurance Ombudsman?

The Insurance Ombudsman is a scheme originally designed by the Government of India. This scheme works for the individual policyholders and assists to solve their complaints. It is the scheme that insurance dispute cases out of the courts system.

Insurance Ombudsman is an efficient, cost-effective, and impartial scheme to solve the insurance dispute.

Where is Insurance Ombudsman Located?

At present, there are 17 centers of Insurance Ombudsman, located in the different regions of the country. 

The following table gives the details of all 17 centers of Insurance Ombudsman:

The following table gives the details of all 17 centers of Insurance Ombudsman:



Email Id


State of Gujarat and Union Territories of Dadra & Nagar Haveli and Daman and Diu






Pradesh and Chhattisgarh






Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir and Union territory of Chandigarh





Tamil Nadu and Union Territories - Pondicherry Town and Karaikal (which are part of Union Territory of Pondicherry)






Kerala, Lakshadweep, Mahe-a part of Pondicherry



Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura





Andhra Pradesh, Telangana and Union Territory of Yanam - a part of the Union Territory

of Pondicherry






Goa, Mumbai Metropolitan Region excluding Navi Mumbai & Thane



Uttaranchal & Uttar Pradesh



Uttar Pradesh



Bihar and Jharkhand



Maharashtra, Area of Navi Mumbai and Thane excluding Mumbai Metropolitan Region



West Bengal, Bihar, Sikkim and Union Territories of Andaman and Nicobar Islands


Likewise, you can approach the Insurance Ombudsman center, in which jurisdiction, your dispute falls i.e. the location of the insurance company office against which you want to complain.

When you can Approach to Insurance Ombudsman?

Once you have presented your complainant to the respective insurance company and it –

  • Refused address your problems/issues by giving any silly reason; or
  • Did not address adequately/satisfactorily; or
  • Not responded in 30 days (of your complainant).

In such a condition, you can approach to the Insurance Ombudsman. However, the condition is – the value of your claim (including expenses claimed) should not be more than 20 Lakhs.

What are the types of Claims, you can Complaint to Insurance Ombudsman?

Following are the major types of claims for which you can approach to Insurance Ombudsman:

  • Any partial or total repudiation of (your) claims by the respective insurer;
  • Unnecessarily delay in settlement of the claims;
  • Any dispute aroused because of the premium paid or payable in terms of the policy;
  • Non-issue of any insurance document even after you have paid your premium;
  • Any dispute in reference to the legal construction of the policies (as far as it relates to claims).

How does Insurance Ombudsman Work?

Insurance Ombudsman is just like a counselor or mediator that works between you and the insurance company. Likewise, it plays an active role and provides a fair recommendation which is based on the facts and circumstances of the dispute.

So, if you accept its recommendation/s as a full and final settlement, then the Insurance Ombudsman inform the insurance company. Based Ombudsman’s recommendation, the insurance company needs to comply the terms in 15 days.

Further, the award decided by Ombudsman is binding on the company but not on you. 

In case, you are not satisfied with the Ombudsman’s decision, you can approach to consumer forum.

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