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Insurance Ombudsman Rules, 2017 · Rules 13–17

Insurance Ombudsman complaint format — for a rejected or unpaid claim

Short answer. The complaint form is already open below, in the same order as the official one — fill it in and file it free of charge. Complaint to the insurer first: Required before the Ombudsman — in writing, by e-mail or on the insurer's website (Insurance Ombudsman Rules, 2017, r.14(3)(a)).

  • Insurer should resolve your complaint, with reasons (14 days): type the date
  • No reply by now? You can go to the Insurance Ombudsman (one month): type the date
  • Last day to file with the Ombudsman if the insurer never replied (one month + one year): type the date

Check your own case.

The 14 days come from IRDAI's Master Circular on Protection of Policyholders' Interests, 2024. Rule 14(3)(a)(ii) of the Insurance Ombudsman Rules, 2017 lets you approach the Ombudsman if there is no reply within one month after the insurer received your complaint; Rule 14(3)(b)(iii) gives one year after that month ends. If you sent the complaint by post, the month runs from delivery — enter the delivery date. If the insurer rejected your complaint or replied and you are not satisfied, the one year runs instead from the date you received that letter (Rule 14(3)(b)(i)–(ii)) — the last day is the same date one year later.

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Start with the insurer's letter: copy their reason word for word into point 7, then say plainly why it is wrong. That is what the Ombudsman reads first.

Note the day you sent your complaint to the insurer. One month later you can file here — and the one-year clock is running from then.

An illustrated character, not a lawyer.

Deadlines

The rules, with the source

WhatDeadlineSource
Complaint to the insurer firstRequired before the Ombudsman — in writing, by e-mail or on the insurer's websiteInsurance Ombudsman Rules, 2017, r.14(3)(a)
Insurer's reply to your complaintAcknowledgement immediately; resolution with reasons within 14 daysIRDAI Master Circular on Protection of Policyholders' Interests, 2024, Section 1, ch. VI, para 2
When you can go to the OmbudsmanInsurer rejected the complaint, did not reply within one month of receiving it, or you are not satisfied with the replyInsurance Ombudsman Rules, 2017, r.14(3)(a)(i)–(iii)
Deadline to file with the OmbudsmanWithin one year of the rejection or final reply, or of the end of the one-month reply periodInsurance Ombudsman Rules, 2017, r.14(3)(b); delay may be condoned, r.14(4)
What the Ombudsman can hearDelay in claim settlement, full or partial repudiation, premium disputes, misrepresentation of terms, policy servicing and moreInsurance Ombudsman Rules, 2017, r.13(1)(a)–(i)
Maximum awardActual loss, not more than ₹50 lakh including expensesInsurance Ombudsman Rules, 2017, r.17(3) proviso (ii), as amended by G.S.R. 828(E) of 09.11.2023
Ombudsman's awardWithin three months of receiving all requirements from the complainantInsurance Ombudsman Rules, 2017, r.17(4)
Insurer pays the awardWithin 30 days of receiving it, with interest from the date the claim ought to have been settled; ₹5,000 per day penalty if not honoured (unless the insurer appeals within 30 days)r.17(6)–(7); IRDAI Master Circular 2024, Section 2, ch. VII, para 25
Same matter in court or consumer forumThe Ombudsman will not take it upInsurance Ombudsman Rules, 2017, r.14(5)

Filing with the Ombudsman is free: in person, by post, by e-mail or online at cioins.co.in. File with the office for the area of the insurer's branch or of your residence (r.14(1)).

Step by step

What to do, in order

  1. 1

    Get the rejection in writing

    Ask the insurer or TPA for the repudiation letter with the exact policy clause. Keep the claim number.

  2. 2

    Complain to the insurer

    Write to the Grievance Redressal Officer by e-mail, on the insurer's website or on Bima Bharosa. Note the date and the complaint number.

  3. 3

    Wait — but not too long

    The insurer should answer within 14 days. After one month without a reply, or once you get a reply you don't accept, you can go to the Ombudsman.

  4. 4

    Fill in the form below

    Facts in date order, the insurer's reason in quotes, why it is wrong, and the amount you claim.

  5. 5

    File with the Ombudsman

    Online at cioins.co.in, by e-mail or by post to the office for your area. Attach the policy, the rejection letter and your complaint to the insurer.

  6. 6

    Mediation or award

    The Ombudsman may mediate or pass an award within three months of having all papers. The insurer must pay an award within 30 days.

Questions

The insurer has not replied at all. Can I still go to the Ombudsman?

Yes. If there is no reply within one month after the insurer received your complaint, you can file. You then have one year from the end of that month.

Is there a fee or do I need a lawyer?

No fee is charged at Ombudsman offices, and you can file yourself. A lawyer is not required.

My claim is above ₹50 lakh. What then?

The Ombudsman cannot award more than ₹50 lakh including expenses. For a bigger claim, a consumer commission or court is the usual route — and you cannot run both on the same matter.

Official sources

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