Irdai on Wednesday proposed a framework mandating appointment of an internal insurance ombudsman for insurers to address complaints involving claims up to ₹50 lakh.
The Insurance Regulatory and Development Authority of India (Irdai), which released the exposure draft of the Internal Insurance Ombudsman Guidelines, 2025, has proposed the establishment of an independent and impartial review mechanism within insurers to address unresolved or escalated complaints in a fair, transparent, and time-bound manner.
"Applicable to all insurers (except reinsurers) with more than three years of operations, the framework mandates the appointment of an internal insurance ombudsman to address complaints involving claims up to ₹50 lakh," it said.
Insurers may also appoint more than one internal insurance ombudsman, with well-defined jurisdiction, to ensure effective coverage and responsiveness, said the draft on which Irdai has invited comments till August 17.
The proposed guidelines lay down the eligibility criteria, tenure, independence, role and responsibilities and remuneration structure of internal insurance ombudsman, along with general principles to be followed by them.
"To reinforce strong governance and oversight, it is proposed that the internal insurance ombudsman shall functionally report to the board or its policyholder protection, grievance redressal and claims monitoring committee, with administrative reporting to the MD/CEO," Irdai said.
It further said that by institutionalising this internal but independent mechanism, Irdai aims to further improve the quality of grievance handling and enhancing overall consumer confidence in the insurance sector.
