Ombudsman recommendation or award: do I have to accept it?

A recommendation comes out of mediation, which needs both sides' written consent, and it takes effect as a settlement only if you accept it in writing within 15 days as full and final; the insurer must then comply immediately, and within 15 days. An award comes when mediation does not settle the complaint: it binds the insurer, which must comply within 30 days. The Rules do not say an award binds you, and the Council for Insurance Ombudsmen says a dissatisfied complainant may take recourse to the normal process of law.

The Insurance Ombudsman Rules provide two ways for a complaint to end: a recommendation under rule 16, after mediation, and an award under rule 17 where mediation does not settle it.^[1]

Side by side

Deciding on a recommendation

Accepting a recommendation means accepting it 'as full and final'. Read it with that in mind: once you accept, you are agreeing that the dispute is settled on those terms. The 15 days run from when you receive it, so note the date. If the complaint is not settled by mediation, the Rules provide for an award instead.^[1]

• Does it cover the whole amount in dispute, or only part of it?
• Does it say anything about interest, or about expenses?
• Is anything left open, such as a later payment or a condition?
• What would you be giving up by accepting, and what would you be relying on if you did not?

After an award

An award binds the insurer, which must comply within 30 days of receiving it and report its compliance to the Ombudsman. You are entitled to interest at the regulations' rate from the date the claim ought to have been settled. IRDAI's circular adds a penalty of ₹5,000 a day, payable to you, if the insurer does not honour the award within 30 days, unless it chooses to appeal within 30 days, in which case it must inform you.^{[1, 2]}

The Rules contain no appeal route for either side. IRDAI's circular nonetheless refers to an insurer appealing within 30 days without naming the forum, so how an insurer appeals is unclear from the official texts. For a complainant who is not satisfied, the Council for Insurance Ombudsmen's FAQ says only that you may take recourse to the normal process of law against the insurer; that is a legal question to take independent advice on.^{[1, 2, 3]}

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