What documents should I attach to an Insurance Ombudsman complaint?

Two documents are mandatory on the Ombudsman's online form: a copy of your complaint to the insurer, and valid ID and address proof. Attach the insurer's rejection or reply, the full policy, a photograph if you file online, and the rest of your correspondence, including with the TPA. If the claim was rejected for a pre-existing disease or a waiting period, the Council for Insurance Ombudsmen also asks for your earlier policies covering the 48 months before the current one.

The Insurance Ombudsman Rules ask a complaint to set out the facts 'supported by documents', together with your loss and the relief you seek. The Council for Insurance Ombudsmen's pages and the online form say which documents it expects.^[1]

The core documents

Add these when your case needs them

• Earlier policies, for PED or waiting-period rejections: The Council's procedure page asks for copies of all old policies covering the 48 months before the current one if the claim was rejected on grounds of pre-existing disease or a waiting period. They show the cover you had before the current policy began.^[4]
• The claim papers: The claim form and what supported it: bills, the discharge summary and test reports for a health claim; the death certificate and claim form for a life claim; the survey report, estimate and bills for a motor claim.
• Medical or expert evidence: A letter from the treating doctor that addresses the insurer's stated reason. See asking your doctor for a letter.
• Proof of dates: Email headers, postal or courier receipts, acknowledgements with reference numbers, and the token number if you also complained on Bima Bharosa.^[6]
• If you complain as a nominee or legal heir: A document showing your connection to the policy, such as the death certificate and the nomination or a legal heir certificate, since the Rules let a legal heir, nominee or assignee complain.^{[1, 2]}

Preparing the files

• Format and size: On the online form, each file must be a PDF or JPG of 10 MB or less.^[2]
• One document per file: Name each file by number, date and what it is, so the office can find it quickly.
• Copies, not originals: The procedure page speaks of photocopies of the supporting documents sent with the complaint letter. Keep the originals. See whether to send originals.^[4]
• A numbered index: List the documents in date order and refer to them by number in the complaint and at any hearing.

ClaimAssure is an independent private platform. It is not an insurer, IRDAI, Bima Bharosa or the Insurance Ombudsman, it never files anything on your behalf, and it cannot promise any outcome. What it does is read your documents and show you what they say.

More on ombudsman complaints