Functioning and powers of Insurance Ombudsman

[S. Anoop Kumar]

Dear Friends,

 

This is for the surveyors who would like to know the functioning of Insurance Ombudsman and the powers that are enjoyed by the Ombudsman.  This will also clear lots of doubts or myths that some of the surveyors were carrying so far.   

 

Insurance Ombudsman is a quasi judicial authority which handles the grievances of the insured on disputed insurance claims leading to early settlement and disposal of the issue on hand at a less cost or almost at no cost to the aggrieved except for the cost of postage, stationery, priniting and one or two visits to the office of the Ombudsman.   The insured can represent his own case.  And insurer's are represented by their own officials.  There is nothing like court fee or admission fee for filing the complaint.  No need for hiring costly lawyers.   

 

The case is to be disposed of in one or two sittings and may take between 30 to 90 days depending upon the pressure on the Ombudsman.   The Ombudsman's orders and directions are final and binding and need to be complied by the insurer's and the insurer's cannot go against the orders of the Ombudsman or further prefer an appeal in the matter.  However, if the insured or the aggrieved is not satisfied with the orders of the Ombudsman, then he/she can always approach the other avenues or fora available to him such as Consumer Forum, filing a suit in a civil court, or filing his complaint before the Directorate of Public Grievances.   As at the time of filing the grievance before the Ombudsman there should be no case or complaint filed and pending before any other authority and also during the pendency of the grievance before the Ombudsman.  

 

While all this looks simple, easy and convenient to read and understand, the crux of the problem lies in the execution of the orders issued by the Ombudsman against the insurer's.   While the orders of the Ombudsman are binding on the insurer's, there is no way Ombudsman can force the insurer's to implement the orders issued by it or punish the insurer's for non-compliance.  The Ombudsman can at best write to the CEO or CMD of the company advising him to comply with the orders and can also write to IRDA bringing the matter to their notice.   This is where the role of the Ombudsman ends.   And there are several hundreds of cases where the Ombudsmen have given orders against the insurer's which have not been complied with and the insured had to still approach other legal fora  for redressal or simply forego the claim.   That is Ombudsman has the powers to direct but has no powers to impose or enforce it's orders.   The private companies have least respect for the office of Ombudsman and there are several thousands of cases pending against them for not executing the orders of Ombudsman and non compliance. 

 

Next, the judgements issued by Ombudsman (should be rightly called as orders)  are not representative in nature and cannot be quoted or taken as reference to decide any other case or claim in any other court or judicial body.   Only orders of high courts or supreme court judgements can be taken as reference.  

 

If this material is interesting, useful and helpful please share your comments. 

 

 S. Anoop Kumar. 

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[santhanam Palaniappan]

Dear Brothers

There is a fire accident in a spinning mill in last month and the mill was commissioned two years back. Machines manufactured in 1985-90s is procured from 2^nd market and installed. The machines are covered under standard fire and special perils policy including DG set. Sum insured of the machines is covered on 45% of the new machinery cost. The loss is claimed by the insured against machinery is fetching Rs 35,00,000/-. Most of the items damaged are cables, switches, panel board, belt and few parts in carding and mixing unit.

 Please opin how to apply average clause and depreciation. 

P Santhanam

[S. Anoop Kumar]

Mr. Santhanam Palaniappan,

 

Can you find even remote connection between the heading and the subject under discussion to the message now posted by you?   You have killed one topic under discussion and also you will not get the desired response for the members go thro messages only after going thro the subject heading.   When you would like to raise a topic & invite comments or advise from others open the subject as a new topic.

 

Regards,

S. Anoop Kumar.