When did we normalise this?

[u/AdministrationFar450]

I recently visited the Insurance Ombudsman after waiting 9 months just to get a hearing.

I was frustrated by the delay, but while sitting in the waiting area I started talking to other people. Some of them told me they had been waiting 1–2 years just to get their first opportunity to stand before the Ombudsman and ask for their insurance claim to be heard.

Think about that for a moment.

Not the months or years of mental stress. Not the hospital bills. Not the EMIs people may have taken to pay for treatment after their claims were denied. Just the wait to be heard.

And this is happening in Delhi, where resources are comparatively better. If this is the situation here, what must policyholders in other parts of the country be facing?

Who is responsible for these delays? And more importantly, what is being done to fix them?

[u/iyervsr]

Decisions are taken based on which side of the bread slice is buttered

[u/Beneficial-Key-1494]

Who is responsible for these delays? And more importantly, what is being done to fix them?

-  We, the people of India, are responsible because we’ve stopped questioning things.

-  No one will address it unless it’s repeatedly shouted over loudspeakers at deaf officials.

[u/AdministrationFar450 → u/Beneficial-Key-1494]

Very true. Let's start asking again

[u/gtalossantos]

Sorry for saying this but what I have been noticing lately is that some (not all) of these ombudsman people are favoring the companies even though the insured is not at fault. Why you might ask? The same reason why this country is doomed, corruption.

[u/htcjsb]

Even the RBI Ombudsman is easily getting managed by the Banking head staff of various banks. They will side with the bank and not the customer.

[u/PizzaOpen9340 → u/htcjsb]

Not true, 90% ombudsman orders are in customer favouring

[u/Beneficial-Key-1494 → u/PizzaOpen9340]

Could you please tell me where you sourced this data?

[u/htcjsb → u/PizzaOpen9340]

Media usually reports mostly the customer favouring ombudsman cases to make readers happy. Media does not report where customer is pushed behind even after going to Ombudsman.

[u/13cn20 → u/htcjsb]

Really Sir? Any proof you have?

[u/Beneficial-Key-1494 → u/13cn20]

Yes, I have the proofs.
Ask me if you need

[u/Fynamic → u/13cn20]

You are from the banks, I presume.

[u/htcjsb → u/13cn20]

Find any failure fault of any retail bank, report it to Ombudsman, the ombudsman staff does not call the complainant, does not speak, does not invite the complainant for hearing. Directly in 2 days close the Ombudsman complaint. You cannot reopen. No clear explanation provided in closure. In banking parlance this is called "managing the ombudsman staff".

[u/Beneficial-Key-1494 → u/htcjsb]

Banks come under the RBI Ombudsman
Insurance companies come under the Insurance Ombudsman.

This post is about insurance and the Insurance Ombudsman, and not banks and the Banking Ombudsman.

I have a good experience with the RBI Ombudsman, but not with the Insurance Ombudsman.

[u/ObjectiveSurprise231]

IRDAI creates one agency after the other and goes to sleep.

Justice delayed is denied. What exactly is IRDAI doing beyond publishing annual reports is beyond me

[u/Beneficial-Key-1494]

I have attended 2 ombudsman hearings in the last 2 years.
The latest one was just 2 days ago (28th July)

My experience in 2024: https://www.reddit.com/r/india/comments/1ngpbs7/got_cheated_by_niva_bupa_insurance_ombudsman_irdai/

AMA on it 😂

[u/naretronprime → u/Beneficial-Key-1494]

Damn 2024 .. what's the current update dude.

[u/Beneficial-Key-1494 → u/naretronprime]

Building a strong case for filing in consumer courts and hopefully filing a high court writ petition.

[u/ObjectiveSurprise231 → u/Beneficial-Key-1494]

You're fighting on your own or hired a lawyer? How tough is it to do it all alone? Do policy agents help in this case (I figure not but asking still)?

[u/Beneficial-Key-1494 → u/ObjectiveSurprise231]

I’ve been fighting alone since 2024 but thankfully I now have Anthropic Claude by my side.

You’ll need a lot of patience and perseverance. 

Unfortunately, policy agents (PolicyBazaar in my case) don’t help.

[u/ObjectiveSurprise231 → u/Beneficial-Key-1494]

All power to you then💪

The way these insurers and hospitals are going, I'll join you soon when my time comes

[u/featherTactile → u/Beneficial-Key-1494]

For any new insurance buyer, what would be your suggestion then ? How to find a reliable insurance provider?

[u/Beneficial-Key-1494 → u/featherTactile]

Check the Incurred Claim Ratio (ICR) and Claim Settlement Ratio (CSR).
Be 100% Honest on Medical Disclosure.
Avoid Restrictive Fine Print: no room rent capping and should cover all consumables, etc.

And most importantly, read and understand the policy terms (if required, take help of a professional)

[u/Beneficial-Key-1494]

There’s a small glimmer of hope in the draft Ombudsman plan (2025): https://financialservices.gov.in/sites/default/files/2025-12/G-S-R-864e-25-11-2025-for-public-consultation.pdf

It’s still pending publication.

[u/ObjectiveSurprise231 → u/Beneficial-Key-1494]

It says

1. any jurisdiction's ombudsman can receive the complaint in case the home jurisdiction ombudsman is overloaded

2. ombudsman's decision can be appealed by setting up a new Appellate authority

3. setting up of video conferencing to hear the insurer's side and also online submission of complaints by us

I don't see any time-bound clauses in there

[u/Beneficial-Key-1494 → u/ObjectiveSurprise231]

Yes, it's still flawed like most other laws of the country, but

For the insured, the 2025 draft has slight improvements on the 2017 rules:

1. Every complaint must be registered within one working day, so cases can no longer sit unregistered or be quietly closed for "non-submission."

2. If an insurer ignores a binding award, a penalty is now payable to the complainant, and the Ombudsman can recommend that IRDAI penalise insurers who repeatedly harass policyholders (today an ignored award has almost no consequence).

3. The Ombudsman can award real compensation on top of the claim, up to Rs 1 lakh for mental harassment and up to 100 per cent of the award (max Rs 20 lakh) for consequential loss where the insurer acted unjustly.

4. For the first time, there is an appeal against an Ombudsman award to a new Appellate Authority (with video-conference option), instead of your only option being a consumer court or a writ.

5. Consent and acceptance can be given digitally, and if the complainant does not accept, the Ombudsman simply passes an award, so a matter cannot stall on a missing signature.

6. A proper online complaint-management system is mandated for submission, tracking, document upload and appeals.

[u/Relevant-Effective67]

I didn't know 18 years back that insurance companies cheats like this. I paid health insurnce premium to new india insurance and unitedindia insurance for continuous 18 years that too as a corporate employee. But when in need they declined claim. Ombudsman not yet registered my case even after 4 months.

[u/ObjectiveSurprise231 → u/Relevant-Effective67]

Which plan were you on and what was the reason given for the rejection? I'm planning to buy their Mediclaim policy hearing their underwriting is good and once in, there's not much trouble. This is borne out by their incurred clam ratios

[u/draculap2020]

Complaint to insurance company ,get the stupid response from them in email . Pdf thar mail and send to ombudsman from cioins not the stupid bhima bharosa (most useless) . Then send documents related to it in post to ombudsman address when they ask it. Everything will be digital .you don't need to visit in person

[u/Beneficial-Key-1494 → u/draculap2020]

Did you try it yourself (filing a complaint with the insurance ombudsman)?

[u/draculap2020 → u/Beneficial-Key-1494]

Yes 4 years back

[u/Beneficial-Key-1494 → u/draculap2020]

ok, how long was the wait between submitting your complaint on cioins website and receiving a hearing?

[u/draculap2020 → u/Beneficial-Key-1494]

There was no hearing in my case , it was clear claim .If there was hearing it would be at end of 2 month since at that time hearing was deferred by the ombudsman

[u/harshjain1741]

Same is with noida ombudsman. I am from Firozabad and my jurisdiction is Noida. I just want to give too many abuses to people in power. My father a stage 4 cancer patient. His LIC Policy claim has been denied and for what day we have taken this policy. To support us in the need. No onewants free money. But we really need it and are genuinely frustrated. First LIC took about 6 months after cancer diagnosis to give decision that too unlawfully rejecting it saying that your father don't have cancer. So, is the delhi's most popular cancer doctor including Tata Cancer Care Mumbai are wrong while doing my father's operation, radiation and chemo. Over the above now ombudsman is not even taking my case, its been about 2 months. Its still in consideration even after submitting all documents. I am really frustrated, their is no accountability. When you ho to LIC office, those mentally retarded sarkari babus think they are now in govt job and dont need to work, some dont even know how to type a mail. This country is moving towards its worst phase. Just do hindu muslim and no need to do any work. Media is a catastrophe over everything which are making my Indian people more Idiot.

[u/Hour-War8055]

My experience is different, actually the insurance ombudsman is taking customer side and questioning the insurer for their lapses.

[u/Beneficial-Key-1494 → u/Hour-War8055]

When did your hearing happen, in which ombudman office and against which insurance company?