IrDA and Insurance Ombudsman in India

Insurance Regulatory and Development Authority (IrDA) is an autonomous, apex and statutory body which regulates and develops the insurance industry in India. It was established under IrDA act 1999, which was passed on the recommendation of the Malhotra Committee report of 1994. IrDA began functioning in April 2000. This agency operates from its headquarters at Hyderabad, where it was shifted from Delhi in 2001.

Functions of IRDA

• Protect the rights of policy holders
• Provide registration certification to life insurance companies
• Renew, Modify, Cancel or Suspend this registration certificate as and when appropriate.
• Promoting efficiency in the conduct of insurance business;
• Promoting and regulating professional organisations connected with the insurance and re-insurance business
• Regulating investment of funds by insurance companies;
• Adjudication of disputes between insurers and intermediaries or insurance intermediaries;

Organizational structure or Composition of IrDA

IRDA is a ten member body consisting of:

• A Chairman (Currently T.S. Vijayan)
  • Five whole-time members,
    • Four part-time members,

All members are appointed by the Government of India.

Insurance Ombudsman

The Insurance Ombudsman is created by Government of India for individual policyholders to have their complaints settled out of the courts in an impartial, efficient and cost-effective way.

There are 12 Insurance Ombudsman in different locations in India that an insured person can approach. Usually complaints are lodged with the ombudsman having jurisdiction over the location of the insurance company office that the insured person has a complaint against.

• Insured persons can approach the Ombudsman with complaint if:
• They have first approached their insurance company with the complaint and the company has not resolved it.
• Not resolved it to the insured person’s satisfaction or
• Not responded to it at all for 30 days
• An insured person’s complaint pertains to any policy you have taken in his/her capacity as an individual and
• The value of the claim including expenses claimed is not above Rs 20 lakh

A complaint to the Ombudsman can be about:

• Any partial or total repudiation of claims by an insurer
• Any dispute about premium paid or payable in terms of the policy
• Any dispute on the legal construction of the policies as far as it relates to claims
• Delay in settlement of claims
• Non-issue of any insurance document to you after you pay your premium
• The settlement process

The Ombudsman acts as counsellor and mediator and arrives at a fair recommendation based on the facts of the dispute.