The Insurance Ombudsman is an official set up by the government to settle disputes with insurance companies, free of charge. Their award is binding on the insurer. But their powers have limits: up to ₹50 lakh, only certain kinds of complaints, and only if certain conditions are met. This article looks at who the Ombudsman is, how they are appointed, which complaints they can and cannot take, what happens once a complaint reaches them, and how many complaints came in last year (2024-25), all from official sources.
For a step-by-step complaint guide, see Insurance claim rejected? What to do and how to complain. This article does not repeat those steps; it explains how the Ombudsman system itself works.
Where does the Ombudsman system come from?
The Government of India created the institution in 1998 under the “Redressal of Public Grievances Rules, 1998”. The rules in force today are the Insurance Ombudsman Rules, 2017 (G.S.R. 413(E)), which came into force on 25 April 2017 and replaced the older ones. They were amended in 2021 and again in 2023 (G.S.R. 828(E), 9 November 2023), according to the CIO annual report 2024-25. The aim of the rules is to settle complaints against insurers, their agents and intermediaries in a low-cost and impartial way (Rule 2).
Who appoints the Ombudsman, and who pays for the system?
“Do they work for the government or for the companies?” is a fair question. Here is what the rules say:
| Point | What the rules say |
|---|---|
| Who appoints | The Council for Insurance Ombudsmen (CIO), which has 9 members: representatives of life and general insurers, a representative of IRDAI and one from the Finance Ministry’s Department of Financial Services (Rule 5) |
| How they are chosen | On the recommendation of a selection committee headed by the IRDAI Chairperson (or a whole-time member he authorises), with experts from the Banks Board Bureau, one person with a record in consumer rights, and the Finance Ministry’s representative (Rule 7) |
| Qualification | Age 55 to 65; either a former civil servant who held the post of Joint Secretary or equivalent in the Government of India, or someone with at least 25 years in the insurance industry who reached a level just below a company director (Rule 7A) |
| Conflict of interest | Candidates must disclose their finances and any links with insurers, and IRDAI’s opinion is taken. An Ombudsman must not handle a matter in which they have an interest (Rules 7B, 13(3)) |
| Term | 3 years or until age 68, whichever is earlier; no reappointment (Rule 8) |
| Removal | For reasons such as gross misconduct, incapacity, insolvency, conviction for an offence involving moral turpitude or conflict of interest, after an inquiry; IRDAI decides (Rule 9) |
| Who pays | IRDAI provides the staff. The running costs are borne by the Life Insurance Council and the General Insurance Council (Rule 12) |
So the insurance industry pays for the system, but IRDAI, the government and a consumer-rights representative have a role in appointments, and there are conflict-of-interest rules. These are facts you can weigh yourself.
How many offices? Which one covers Andhra Pradesh and Telangana?
According to the CIO’s 2024-25 report, the Thane office began working on 27 December 2024, making it the 18th office. (The CIO website FAQ still says 17; that may be out of date.) Each Ombudsman has a territorial jurisdiction (Rule 11). You can file with the office whose area covers either the branch of the insurer you are complaining about, or the place where you live (Rule 14(1)).
Hyderabad office: covers Andhra Pradesh, Telangana, Yanam and part of Puducherry (CIO website). Address: 6-2-46, 1st floor, “Moin Court”, Lane Opp. Hyundai Showroom, A. C. Guards, Lakdi-Ka-Pool, Hyderabad – 500 004. Email: oio.hyderabad@cioins.co.in. Phone: 040-23312122 / 23376991 / 23376599 / 23328709 / 23325325. We have not listed the Ombudsman’s name because it can change; check the CIO website for current details before you go.
Which complaints can the Ombudsman take?
Under Rule 13, you can complain about a deficiency in service by an insurer (including its agents and intermediaries) or an insurance broker on any of these grounds:
| Rule 13(1) | In plain words |
|---|---|
| (a) | Delay in settling a claim beyond the time set in the regulations |
| (b) | Partial or total rejection of a claim (life, general or health) |
| (c) | Dispute over premium paid or payable |
| (d) | Misrepresentation of policy terms in the policy document or contract |
| (e) | Dispute over how policy terms should be read, where it relates to a claim |
| (f) | Policy servicing problems (for example change of address or nominee, agent service) |
| (g) | A policy issued that does not match the proposal form you submitted |
| (h) | No policy issued after the premium was received |
| (i) | For matters under (a) to (h), failure to follow IRDAI regulations, circulars or the policy’s own terms |
“Deficiency” here has the meaning given in the Consumer Protection Act, 2019 (explanation to Rule 13(1)). The government or IRDAI can also refer a complaint directly to the Ombudsman (Rule 13(4)). You can complain against private and public sector insurers, in life, health and general insurance (CIO FAQ).
Who can complain?
- Holders of individual (personal lines) policies
- Members of a group policy (for example group health from an employer), if the claim is payable to that individual (or, if they have died, to their heirs or nominee)
- Sole proprietors and micro enterprises. The CIO FAQ, quoting the MSME notification of 21 March 2025, says a micro enterprise is one where investment in plant, machinery or equipment does not exceed ₹2.5 crore and turnover does not exceed ₹10 crore
- The policyholder in person, or their legal heirs, nominee or assignee (Rule 14(1))
- Complaints can also be made against insurance brokers
The CIO FAQ says partnership firms, corporate bodies, co-operative societies, associations and trusts cannot use the system.
Which complaints will they NOT take? (The limits)
Check this list before you file. If any of these conditions fails, the complaint is “non-entertainable”, meaning it is not taken up.
| Limit | Detail | Basis |
|---|---|---|
| You did not first complain to the insurer in writing | You must first complain in writing (letter, email or online) to the insurer or broker. You can go further if it rejects your complaint, you are not satisfied, or you get no reply within a month | Rule 14(3)(a) |
| Time limit passed | Within one year of receiving the insurer’s rejection or reply (if there is no reply, within one year after the one-month wait). The Ombudsman may condone a delay for good reason, after hearing the insurer’s objections and recording reasons, but that is their discretion | Rule 14(3)(b), 14(4) |
| The same matter is in a court, consumer forum or arbitration (or was already decided) | You cannot run both at once | Rule 14(5), FAQ 10 |
| Amount above ₹50 lakh | The compensation sought must not exceed ₹50 lakh | CIO FAQ, IRDAI circular 2024 |
| Outside the system | Business policies of larger companies, partnership firms, trusts and so on | Rules 2, 3; FAQ 20 |
| Not about insurance service | Agent licence not issued, commission not received, grievances of company employees | FAQ 22 |
| Ex-gratia payment | The Ombudsman cannot award a payment made out of kindness beyond the policy terms | FAQ 14 |
One thing to note: the copy of the rules on the CIO website (amended till 02-03-2021) shows the compensation limit in Rule 17 as ₹30 lakh. The CIO FAQ and IRDAI’s Master Circular of 5 September 2024 say the current limit is ₹50 lakh. We did not find the gazette text of the amendment that changed it, so we rely on these two official statements and use ₹50 lakh.
What powers does the Ombudsman have?
- Ask for more documents from both sides, and collect factual information held by the insurer and share it with the other party (Rule 15(2))
- Take expert opinion if the case needs it (Rule 15(3))
- Hold a hearing: both sides must get a reasonable chance to be heard (Rule 15(4)); hearings can be in person or by video conference (Rule 15(5), FAQ 16), including, where warranted, at other places within the jurisdiction (FAQ 17)
- Act as counsellor and mediator if both parties agree in writing (Rule 13(2))
- Pass an award if mediation does not settle the matter; it is binding on the insurer (Rule 17(8))
What happens after a complaint reaches the Ombudsman?
| Stage | What happens | Time |
|---|---|---|
| 1. Complaint | In writing with signature, by email, or online on the CIO website. It must give your name and address, the branch complained against, the facts (with documents), the loss and the relief you want | Within 1 year of the insurer’s reply |
| 2. Examination | Documents sought, information collected from the insurer, expert opinion if needed, hearing | – |
| 3a. Mediation (if both sides agree in writing) | The Ombudsman makes a “recommendation” they think fair. If you accept, you must say so in writing within 15 days, as “full and final”. The insurer must then comply immediately, within 15 days at most | Recommendation within 1 month; your reply in 15 days; insurer in 15 days |
| 3b. Award (if no mediation) | A written award with reasons, based on pleadings and evidence. It states the compensation after deducting any amount already paid | Within 3 months of receiving all requirements from you |
| 4. Compliance | The insurer must comply with the award within 30 days and tell the Ombudsman. If late, it owes you ₹5,000 for each day of delay, in addition to penal interest. This does not apply if the insurer appeals within 30 days, and it must then inform you (the circular does not say before which forum the insurer may appeal) | 30 days |
Sources: Rules 14-17, IRDAI Master Circular (5 September 2024) pages 110-111, CIO FAQ.
How much can the Ombudsman award?
- No more than the loss you suffered as a direct result of the cause of action
- An overall limit of ₹50 lakh, including relevant expenses (CIO FAQ)
- You are also entitled to interest, as set in IRDAI regulations, from the date the claim should have been settled until the date of payment (Rule 17(7))
- No ex-gratia compensation
What if you do not like the award?
The award binds the insurer (Rule 17(8)). If you are not satisfied with the decision, the CIO FAQ (question 21) says you may take recourse to the normal process of law, for example a consumer commission or a court. Getting legal advice at that stage is sensible. The rules have no provision to engage a lawyer before the Ombudsman (FAQ 12); you can put your case yourself.
An imagined example
Venkatesh from Nellore has a health claim for ₹1,50,000. The insurer pays ₹90,000 and rejects the other ₹60,000. (This is an imagined example to explain the idea; dates and amounts are for illustration only.)
| Date | What happened | Which rule |
|---|---|---|
| 5 January | He files a complaint on the insurer’s grievance portal | Rule 14(3)(a): first to the insurer, in writing |
| 19 January | The insurer replies, upholding its rejection (within 14 days) | Insurer’s 14-day deadline |
| 10 February | He files online with the Hyderabad Ombudsman (₹60,000, under ₹50 lakh; within a year of the reply; no court case) | Rule 14(3)(b), 14(5) |
| 1 March | Both sides agree in writing to mediation | Rule 13(2) |
| 28 March | The Ombudsman gives a recommendation (within a month of consent) | Rule 16(1) |
| 5 April | He accepts in writing as “full and final” (within 15 days) | Rule 16(2) |
| Within 15 days after | The insurer must comply and tell the Ombudsman | Rule 16(3) |
Without mediation, an award would come within 3 months. Which side the result favours cannot be known in advance; it depends on the policy terms and documents in each case.
In numbers: what happened in 2024-25?
From the CIO annual report 2024-25 (1 April 2024 to 31 March 2025), table “Life, General & Health Insurance (Insurer + Broker)”:
| Item | All offices (India) | Hyderabad office (AP, Telangana) |
|---|---|---|
| Pending at start of year | 7,202 | 0 |
| Received during the year | 53,102 | 2,311 |
| Total (old + new) | 60,304 | 2,311 |
| Disposed of | 48,898 | 1,728 |
| – by mediation (recommendations) | 15,191 | 579 |
| – awards in favour of complainants | 9,234 | 395 |
| – awards in favour of the insurer | 8,937 | 184 |
| – withdrawn by complainants | 5,883 | 450 |
| – not entertained (non-entertainable) | 9,653 | 120 |
| Pending at year end | 11,406 | 583 |
The report also shows how long the disposed complaints took (counted from receipt of the complaint):
| Time taken to dispose | All India | Hyderabad |
|---|---|---|
| Within 1 month | 25,779 | 1,221 |
| 1 to 2 months | 11,333 | 376 |
| 2 to 3 months | 2,740 | 111 |
| 3 months to 1 year | 6,452 | 20 |
| More than 1 year | 2,594 | 0 |
What these numbers do and do not tell you:
- Of 48,898 complaints disposed of across India, 9,653 (nearly one in five) were “non-entertainable”. So read the rules (time limit, first complaining to the insurer, the ₹50 lakh limit, a pending court case) before you file.
- Awards went both ways: 9,234 for complainants and 8,937 for insurers. Going to the Ombudsman does not guarantee a result in your favour.
- Most complaints (25,779 nationally, 1,221 in Hyderabad) were disposed of within a month, but some took longer than three months. These figures count from when the complaint was received, while the rule’s three-month clock runs from receipt of all requirements, so the two cannot be compared directly.
- We have not shown the types of complaints (for example how many were claim rejections); the report gives that in separate tables.
Ombudsman, Bima Bharosa, consumer commission: what is the difference?
| Route | What it does | Fee |
|---|---|---|
| Insurer’s grievance system | The first step. The insurer must reply within 14 days with reasons | None |
| IRDAI Bima Bharosa portal | Registering and tracking a complaint; the insurer still resolves it. Insurers’ systems are linked to it | None |
| Insurance Ombudsman | Decides whether the insurer’s decision was right; mediation or a binding award (up to ₹50 lakh) | None |
| Consumer commission, court | The normal legal route for cases outside the Ombudsman’s scope or where you disagree with the outcome. If the same matter is pending there, the Ombudsman will not take the complaint | Outside this article |
Beware of fraud
Complaining to the Ombudsman is free (CIO FAQ). If anyone asks for a fee to “get your case decided”, it may be a fraud. IRDAI and the CIO also warn people not to give personal information to strangers (CIO annual report 2024-25, page 5; IRDAI circular, section VII). For online complaints, use only the CIO website, cioins.co.in.
Key terms
| Term | Simple meaning |
|---|---|
| Ombudsman | An official who examines complaints impartially |
| CIO (Council for Insurance Ombudsmen) | The body that appoints Ombudsmen and runs the system |
| Award | The Ombudsman’s written decision; binding on the insurer |
| Recommendation | A suggestion made in mediation when both sides agree |
| Non-entertainable | A complaint not taken up under the rules |
| Condone delay | Allowing a late complaint for good reason |
| Sole proprietorship | A business owned by one person, with no separate legal existence |
| Ex-gratia | A payment made out of kindness rather than under the policy terms |
Common myths and facts
| Myth | Fact |
|---|---|
| “The Ombudsman is a court” | It is a complaint-resolution system under the Ombudsman Rules, not a court. The award binds the insurer |
| “They take claims of any amount” | Up to ₹50 lakh only |
| “I can go straight to the Ombudsman” | You must first complain to the insurer in writing |
| “The Ombudsman always sides with the complainant” | In 2024-25 awards went both ways (9,234 for complainants, 8,937 for insurers) |
| “I need a lawyer and a fee” | No fee; the rules have no provision for engaging a lawyer |
| “I can go to the Ombudsman even while a court case is on” | If the same matter is pending, the complaint is not taken up |
| “There is no deadline” | One year from the insurer’s reply |
What to check before you complain
- Does your complaint fit one of the nine grounds in Rule 13?
- What kind of policyholder are you? Individual, group member, sole proprietor or micro enterprise only.
- Did you first complain to the insurer in writing, and keep the dates and complaint number?
- Is it within one year of the insurer’s reply?
- Is the amount under ₹50 lakh, and is there no court or consumer-forum case on the same matter?
- Which office: the one covering your residence or the insurer’s branch. For AP and Telangana, Hyderabad.
- Documents needed (CIO FAQ): a copy of your complaint to the insurer, the insurer’s rejection letter, the policy copy, a KYC document (for example a driving licence), and a photograph for online filing.
- Do not trust anyone who asks for a fee.
Sources
- Insurance Ombudsman Rules, 2017 (copy published by the CIO, amended till 02-03-2021): Rules 2, 3, 5, 7, 7A, 7B, 8, 9, 11, 12, 13, 14, 15, 16, 17. Note: this copy shows the compensation limit as ₹30 lakh; the current limit is ₹50 lakh (CIO FAQ, IRDAI circular).
- CIO FAQs: the ₹50 lakh limit, jurisdiction, eligibility, ex-gratia, lawyers, appeal, micro enterprise definition, documents
- CIO list of Ombudsman offices: Hyderabad office address and jurisdiction
- CIO annual report 2024-25: the 18th office (Thane), the 2023 amendment, complaint statistics (page 34, Statement L1G1H1)
- IRDAI Master Circular on Protection of Policyholders’ Interests (Ref: IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 September 2024), section VI (pages 110-111): 14-day reply, ₹50 lakh, free of charge, award compliance in 30 days, ₹5,000 a day, appeal
All sources above were checked on 22 October 2026. Last updated: 22 October 2026.