Have an insurance claim-related grievance?
Here's how you can file a complaint with the Bima Lokpal, or Insurance Ombudsman
Oct 13, 2025
Synopsis
Policyholders can approach the Bima Lokpal, or Insurance Ombudsman, to resolve their disputes with the insurer without incurring any costs. Read our story to know more about how you can file a complaint regarding your bad experience with a life insurance or general insurance policy with the insurance ombudsman and what you should know before doing so.
If your life insurance company or general insurance company has delayed, mishandled, or worse, outrightly rejected your claim without any valid reason or by citing vague exclusions, you don't have to let it slide.
Policyholders can approach the Bima Lokpal, or Insurance Ombudsman, to resolve their disputes with the insurer without incurring any costs.
Read on to know more about how you can file a complaint regarding your bad experience with a life insurance or general insurance policy with the insurance ombudsman and what you should know before doing so.
When can you approach the Bima Lokpal?
You can approach the insurance ombudsman with any claim-related complaints where the "quantum of loss payable under the insurance policy does not exceed Rs 50 lakhs," as per the ombudsman's website. This means if you are seeking over Rs 50 lakh in compensation, either related to your policy claims or other damages, the insurance ombudsman would be of little help to you.
You do not need a lawyer to approach the ombudsman, nor do you need to pay any charges while complaining to the insurance ombudsman. However, before approaching the insurance ombudsman, you have to approach your insurance company and wait for one month for it to resolve your issue. If you do not get any response or are not satisfied with its response, you can approach the insurance ombudsman within 1 year from the date of rejection of your claim or complaint by your insurer.
You cannot lodge a claim-related complaint after over a year has passed since your claim was rejected. These are the major areas related to which you can approach the ombudsman:
1. Delay in settlement of claims, beyond the time specified in the regulations framed under the Insurance Regulatory and Development Authority of India Act, 1999. As per the IRDAI Master Circular on Policyholder Protection, 2024, all claims (except cashless) should be settled within 15 days from the date of claim receipt.
2. Any partial or total repudiation of claims by the life insurer, general insurer or the health insurer;
3. Disputes over premiums paid or payable in terms of the insurance policy;
4. Misrepresentation of policy terms and conditions at any time in the policy document or policy contract
5. Legal construction of insurance policies insofar as the dispute relates to a claim;
6. Policy servicing related grievances against insurers, their agents, and intermediaries;
7. Issuance of a life insurance policy or a general insurance policy, including a health insurance policy, which is not in conformity with the proposal form submitted by the proposer;
8. Non-issuance of an insurance policy after receipt of premium in life insurance and general insurance, including health insurance; and
9. Any other matter arising from non-observance of or non-adherence to the provisions of any regulations made by the Authority about the protection of policyholders' interests or otherwise.
You cannot approach the insurance ombudsman if you have already lodged the same complaint in the court, a consumer forum, or another arbitrator, and they are pending before them.
What should you keep in mind while filing a complaint with the Insurance Ombudsman?
Anita Teli, Chief Compliance Officer, Probus Insurance, suggests that, first off, policyholders should formally lodge their grievance with the insurance company and give them one month to respond. If the issue is still not resolved, only then can a complaint be made with the ombudsman. Here, the policyholder should be prepared.
"It is important to include all documentation related to the matter, such as the policy, all correspondence with the insurance company, the letter stating the claim was not accepted, and all medical records or evidence regarding the claim. Alongside this, policyholders should include a clearly articulated complaint that describes the situation. Being able to focus the complaint on the facts and keep it within a concise narrative of the argument helps to get the matter the required attention it needs", she adds.
As per the CIO (Council of Insurance Ombudsman) website, policyholders need to keep the following documents handy while approaching them:
1. Copy of representation submitted to Insurance Company/ Insurance Broker
2. KYC particulars: Aadhar card, Pan Card, Driving License, etc
3. Photograph (in case of online registration of complaints)
4. Letter from Insurance Company/ Insurance Broker rejecting the representation / repudiating the claim.
5. Copy of Insurance Policy
Once a complaint has been initiated with the Bima Lokpal, the disposition typically takes 60 to 90 days to complete, Teli says. However, if you agree to mediation, then the Insurance Ombudsman will try to resolve the issue by agreement. If both parties agree to mediation, the ombudsman shall give their recommendation within 30 days from the date they receive a written agreement from both parties.
As per the CIO Annual Report for FY2023-24, the ombudsman received a total of 56,907 complaints related to health, life and other general insurances. Out of these, around 29,506 were disposed of within 30 days, and another 11,419 were disposed of within 30-60 days.
"If the mediation is unsuccessful or they don't choose to mediate, then the Ombudsman will dispose of the case by issuing an award within three months from the date the case has been assigned to him and he has received all required information from the complainant", she explains.
The ombudsman can either issue a recommendation, which is not binding on the insurer, or a monetary award in favour of either the insurer or the policyholder, depending on the case at hand. As per the CIO report, during 2023-24, the CIO issued 15,528 recommendations, 9,287 awards in favour of the complainant or insured, and 8,638 awards in favour of the insurer.
Can the insurance company choose not to comply with the Insurance Ombudsman's award?
Under Rule 17(6) and 17(8) of the Insurance Ombudsman Rules, 2017, awards are binding on insurers and must be implemented within 30 days of receipt. If an insurer fails to comply within 30 days, it must pay the policyholder a penalty of Rs 5,000 per day until compliance. However, there is no forum that the policyholder can approach in case the insurer fails to comply with this.
Aditya Chopra, Managing Partner, The Victoriam Legalis, adds that the Ombudsman lacks the machinery of execution and implementation of such awards. "While the IRDAI may levy regulatory penalties, including the statutorily prescribed sum of Rs 5,000 per day for delay, such penalties accrue to the Protection Fund and not to the beneficiary directly. Consequently, the effective remedy for an aggrieved policyholder, faced with insurer recalcitrance, remains the invocation of the jurisdiction of the Consumer Commissions under the Consumer Protection Act, 2019, wherein the award of the Ombudsman operates as persuasive evidence and strong equitable support".
"In sum, the award is binding in theory and in law, but in practice, it is the supervisory authority of IRDAI coupled with recourse to consumer fora that transforms such an award into a realisable entitlement", he adds.
In some cases, insurers also choose to begin criminal proceedings against the policyholder, even after the ombudsman has ruled in the insured's favor. Alay Razvi, Managing Partner, Accord Juris, highlights, "Insurers occasionally also pursue criminal complaints under Section 154 CrPC, alleging offenses such as cheating (IPC 420), forgery (IPC 468/471), or conspiracy (IPC 120B). The Supreme Court has held that civil and criminal proceedings may run in parallel if the facts disclose prima facie criminality, though courts remain alert to prevent abuse of process."
[The Economic Times]
