Insurance Ombudsman: How to File a Complaint Against an Insurer

If your insurer rejects a claim, settles it only in part, or does not reply within a month, you can complain to the Insurance Ombudsman. Filing is free, the claim must be up to ₹50 lakh, and you have one year from the insurer’s final reply to file. Complaints go online through the Council for Insurance Ombudsmen (CIO) portal, or by email, post or in person.

Key facts

When you can go to the Ombudsman

Rule 13 of the Rules lists the complaints an Ombudsman can hear. They cover insurers, their agents and intermediaries, and insurance brokers:

• Delay in settling a claim beyond the time IRDAI’s regulations allow.
• Full or partial rejection of a claim by a life, general or health insurer.
• Disputes over premium paid or payable.
• Misrepresentation of policy terms.
• Disputes over how the policy wording applies to a claim.
• Policy servicing complaints.
• A policy that does not match your proposal form, or no policy issued after you paid the premium.

The scheme covers personal policies, group policies, and policies of sole proprietors and micro enterprises. Group members can complain where the benefit is paid to them individually.

When you cannot

• The same dispute is pending before, or already decided by, a court, consumer commission or arbitrator.
• You have not first written to the insurer.
• The complaint is about an agent’s licence, commission or an employee grievance. The CIO lists these as outside its scope.

First step: the insurer and Bima Bharosa

Write to the insurer’s grievance cell first, by letter, email, its website or its call centre. Keep a copy, because the Ombudsman will ask for it. IRDAI’s Master Circular on Protection of Policyholders’ Interests, 2024 requires insurers to acknowledge a complaint at once. They must resolve it within 14 days, and a rejection must give reasons tied to the policy terms. The CIO’s own guidance gives the insurer 30 days.

You can also log the complaint on IRDAI’s Bima Bharosa portal, which is linked to insurers’ grievance systems. Bima Bharosa does not ask complainants for any payment. Our page on IRDAI rules and grievance redressal covers the wider regulator framework; this guide deals only with the Ombudsman step.

The one-year clock starts when you receive the rejection or an unsatisfactory reply. If the insurer never replies, it starts one month after you sent your complaint. The Ombudsman can condone a late complaint after asking the insurer for its objections.

Filing online on the CIO portal

1. Open cioins.co.in and click Register Complaint under Complaint Online.
2. Fill in every field: your details, the insurer or broker, the policy, what happened and the relief you want.
3. Upload the documents listed in the next section.
4. Submit the form and enter the OTP sent to your mobile number.
5. Note the online complaint number shown on screen.
6. To check progress later, use Track Complaint with your registered mobile number and an OTP.

File with the Ombudsman office covering either the insurer’s branch or your home address. The CIO website lists the offices and their areas. You can also send a signed complaint by email or post, or deliver it in person. A specimen complaint form is on the same site.

Documents and the claim limit

The CIO’s online FAQ asks for:

• A copy of your complaint to the insurer or broker.
• KYC documents, such as Aadhaar, PAN or a driving licence.
• The insurer’s rejection letter or email, if you received one.
• A copy of the policy.
• A photograph.
• Supporting papers, such as claim forms, hospital bills or correspondence.

The compensation you seek must not exceed ₹50 lakh. The Finance Ministry raised the limit from ₹30 lakh in November 2023, as Business Standard reported. An Ombudsman cannot award more than the loss you suffered as a direct result of the dispute, and does not grant ex-gratia payments.

If your claim was turned down, check the reason against the policy wording before you file. Our guide on why life insurance claims get rejected covers the common grounds.

Hearing, award and payment

Mediation

If both sides agree in writing, the Ombudsman can mediate. A recommendation follows within one month of that consent. If you accept it, write back within 15 days saying you accept it as full and final. The insurer must then comply within 15 days.

Award

Without a settlement, the Ombudsman hears both sides and passes a written award with reasons. The hearing can be in person or by video conference. The award is due within three months of the Ombudsman receiving everything needed from you.

Payment by the insurer

• The insurer must comply within 30 days of receiving the award.
• It must also pay interest at 2% above the bank rate, from the date the claim should have been settled.
• If it does not honour the award within 30 days, IRDAI’s 2024 circular makes it pay you ₹5,000 for each day of delay. That penalty does not apply where the insurer has appealed against the award within 30 days.

If you disagree with the award

Rule 17(8) makes the award binding on the insurer or broker. It does not bind you. The CIO says a complainant who is not satisfied can pursue other legal remedies against the company. Because a complaint cannot run before the Ombudsman and a court at the same time, decide on one route at a time.

For a large or complex claim, a lawyer or consumer-rights adviser can help you choose between the Ombudsman and a consumer commission.

Proposed changes

On 25 November 2025 the Finance Ministry published the draft Insurance Ombudsman (Amendment) Rules, 2025 for public comment. The draft proposes an appellate authority to hear appeals against awards and changes to compensation rules. It was still a draft when Cyril Amarchand Mangaldas reviewed it in June 2026, so the rules above continue to apply.

Frequently asked questions

Is there a fee to file a complaint with the Insurance Ombudsman?

No. The CIO does not charge any fee to file or process a complaint.

What is the maximum claim the Insurance Ombudsman can handle?

₹50 lakh. For a larger dispute you would need a consumer commission or court.

How long do I have to file an Ombudsman complaint?

One year from the insurer’s rejection or reply. If the insurer never replied, the year runs from one month after you sent your complaint.

My health insurance claim was rejected. Can I go straight to the Ombudsman?

No. First send a written complaint to the insurer. Once it rejects that complaint, replies unsatisfactorily, or stays silent for a month, you can file.

Do I need a lawyer for an Ombudsman hearing?

No. The CIO says the Rules make no provision for engaging a lawyer, and hearings can be held by video conference.

How long does the Ombudsman take to decide?

The Rules require an award within three months of receiving all requirements from you. A mediated recommendation is due within one month of both sides consenting.

What if the insurer does not pay the award?

It must pay within 30 days. After that, IRDAI’s rules make it pay you ₹5,000 a day, plus interest, unless it has appealed within 30 days.

Sources

• Council for Insurance Ombudsmen home page — CIO (checked 16 Sep 2026)
• Procedure to lodge a complaint — CIO (checked 16 Sep 2026)
• FAQ on online complaints — CIO (checked 16 Sep 2026)
• General FAQs — CIO (checked 16 Sep 2026)
• Insurance Ombudsman Rules, 2017 as amended till 18.05.2021 — CIO (checked 16 Sep 2026)
• Bima Bharosa grievance portal — IRDAI (checked 16 Sep 2026)
• Master Circular on Protection of Policyholders’ Interests, 2024 (IRDAI/PP&GR/CIR/MISC/117/9/2024) — IRDAI, copy hosted by CAalley (checked 16 Sep 2026)
• Ombudsman limit raised to ₹50 lakh — Business Standard (checked 16 Sep 2026)
• Insurance Ombudsman and the case for consent-based mediation — Cyril Amarchand Mangaldas (checked 16 Sep 2026)