Ombudsman Complaints in India: Jurisdiction, Limits, and a Winning Case
The Ombudsman cannot award punitive damages beyond policy terms, requires the insurer complaint first, and is not a court - complex fraud or over-limit claims belong in consumer forums.
Eligibility
Individual policyholders, claims within the award limits (up to Rs 50 lakh for life), a prior complaint to the insurer with no resolution in 30 days or an unsatisfactory reply, and filing within one year of the insurer's final reply.
Building a winning case
A clean chronology - purchase, premiums, claim, rejection, grounds - quoting the exact policy clause the insurer relied on and why it should not apply, with medical evidence or legal citations such as Section 45.
Drafting the complaint, arranging evidence, and following through is exactly what claim recovery specialists do. See the Insurance Ombudsman guide at Insurance Support for free guidance.