Health & claims
How do you file a complaint with the Insurance Ombudsman?
The Insurance Ombudsman, also called Bima Lokpal, settles disputes between policyholders and insurers for free, with no lawyer involved. You can file once the insurer has rejected your written complaint or not replied within a month, and you must file within one year. It handles claims of up to ₹50 lakh.
In short
- The Ombudsman is free, and the rules make no provision for a lawyer.
- File only after a written complaint to the insurer is rejected or unanswered for a month.
- You must file within one year; claims up to ₹50 lakh.
- In 2024-25, 76% of health cases decided on merit went the policyholder’s way.
What is the Insurance Ombudsman?
An independent forum, set up under the Insurance Ombudsman Rules, 2017, that settles complaints against insurers. It is also called Bima Lokpal, and it is run through the Council for Insurance Ombudsmen. It costs nothing to use, and most hearings are now held online.
When can I complain to the Ombudsman?
After you have complained to the insurer in writing, and the insurer has rejected the complaint, given a reply you don’t accept, or not replied within one month. The complaint must reach the Ombudsman within one year of the rejection, or of that month passing, and the amount you seek must not exceed ₹50 lakh.
How do I file?
Online, by email, or at the Ombudsman office for your area. Describe what happened in plain words and attach the papers: the policy, the insurer’s rejection or deduction letter, your written complaint to the insurer and its reply, and for a health claim, the discharge summary and bills. You do not need a lawyer.
Is it worth complaining?
For health claims, often yes. In 2024-25, health made up 61.5% of the complaints the Ombudsman received, and where a health case was decided on its merits, 76% of decisions went in the policyholder’s favour. Yet only a small fraction of people whose claims are cut ever get that far.
Does the insurer have to follow the decision?
Yes. The award binds the insurer, which must comply within 30 days. It does not bind you: if you are not satisfied, you remain free to go to a consumer commission or court.
Frequently asked questions
Is the Insurance Ombudsman free?
Yes. There is no fee, and the Insurance Ombudsman Rules make no provision for engaging a lawyer.
What is the time limit to complain to the Ombudsman?
One year from the insurer's rejection of your written complaint, or from one month passing without a reply.
What is the maximum claim the Ombudsman can handle?
Claims where the compensation sought does not exceed ₹50 lakh.
Is the Ombudsman's decision binding?
It binds the insurer, which must comply within 30 days. You can still go to a consumer commission or court if you are not satisfied.
What happens when you talk to us
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A note on this page. Everything here is general information, not legal advice, and nothing is an offer. Rules are per the Insurance Ombudsman Rules, 2017, as amended, and figures are from the Council for Insurance Ombudsmen Annual Report 2024-25, at the review date; check cioins.co.in before filing. For help with your situation, talk to us.