How to File a Complaint with the Insurance Ombudsman – Step-by-Step Guide

If you have an issue with your insurance policy—whether it’s health, life, or general insurance—and you’re not happy with the way the company or its agent has handled your complaint, you can approach the Insurance Ombudsman. This guide will walk you through the process in a clear and simple way.

Who Can File a Complaint?

You can file a complaint if:

You are the policyholder, or
A claimant, nominee, assignee, or legal heir of the policyholder.

Also, the policy must be:

For personal use
A group insurance policy
A policy issued to a sole proprietorship or micro enterprise

Step 1: First, Contact Your Insurer or Broker

Write a complaint letter or email to your insurance company or insurance broker.
Clearly mention your policy number, the issue you’re facing, and what resolution you expect.
Keep a copy of all communication for your records.

Step 2: Wait for Their Response (30 Days)

The insurer/broker should respond to your complaint within 30 days.
If they don’t reply within this time or you’re not satisfied with their response, you can move to the next step.

Step 3: Approach the Insurance Ombudsman

You can contact the Ombudsman if:

Your complaint was not resolved within 30 days, or
You are unhappy with the solution provided

Important Conditions:

Your claim (including expenses) should not be more than ₹50 lakhs
You must approach the Ombudsman within 1 year from the date your claim was denied, partly settled, or not handled
You should not have gone to court or any other legal forum for the same complaint

Good to Know: No Fees Charged

Filing a complaint with the Insurance Ombudsman is completely free.

What Complaints Are Accepted?

The Ombudsman will look into cases such as:

Delay in claim settlement
Rejection or partial settlement of claims
Premium disputes
Misrepresentation of policy terms
Issues with policy servicing
Policy issued differently from what was proposed
Non-issuance of policy after premium payment
Violation of regulations, guidelines, or policy terms

Step 4: Submit Your Complaint in Writing or Online

You can submit your complaint:

In writing, signed by you (or legal heir/nominee/assignee)
Through email
Or register online at 👉 www.cioins.co.in under “Register – Lodge/Track Complaint Online”

Attach these documents:

Copy of your insurance policy (all pages)
Old policies (if claim is denied due to pre-existing diseases)
Denial/rejection/partial settlement letter from insurer
Complaint letter sent to the insurer/broker
Any other correspondence with insurer/broker/TPA
Your ID proof and photograph

You can upload these documents online or send them by post/email to the appropriate Insurance Ombudsman office as per your region. You can find the contact details and jurisdiction areas on the same website.