Context:
Insurance regulator IRDAI proposed a framework that mandates a internal insurance ombudsman scheme for insurance companies with an aim to address complaints against claims up to Rs 50 lakh.
Key Objectives
- Establish a transparent, fair, and time-bound grievance redressal mechanism within insurance companies.
- Improve the efficiency and accountability of insurers in handling unresolved or escalated complaints.
- Complement existing external grievance redressal mechanisms.
Applicability
- Applicable to all insurers except reinsurers.
- Mandatory for insurers with more than three years of operation.
- Insurers may appoint multiple ombudsmen with defined jurisdictions for better coverage.
Key Provisions of the Draft Guidelines
- Jurisdiction and Powers
- Internal Insurance Ombudsman can hear complaints involving claims up to ₹50 lakh.
- Ombudsman decisions will be binding on the insurer.
- Eligibility Criteria
- Minimum age at entry: 55 years
- Maximum term: 3 years or till age 70 years, whichever is earlier
- Experience requirement: Minimum 20 years in the insurance industry, and must have held a post not less than two levels below Director
- Impartiality condition: Must not be currently employed or previously employed with the insurer or its group companies
- Reporting Structure
- Reports administratively to the Managing Director/CEO of the insurer
- Reports functionally to the Board or the Policyholders’ Protection & Grievance Redressal & Compliance Monitoring (PPGR & CM) Committee
