The Rules create a statutory grievance redressal framework for life and general insurers, governed by an Insurance Council and its Governing Body which appoints Ombudsmen. Ombudsmen have specified jurisdiction, powers to receive complaints on claim repudiation, premium disputes, policy construction related to claims, delays and non issuance of documents, and may mediate or award relief. Complaints require prior written representation to the insurer and are subject to filing limits and bars where court or tribunal proceedings exist. Awards and mediated settlements follow prescribed acceptance and compliance procedures, and an Advisory Committee reviews Ombudsman performance. (AI Summary)
TaxTMI