Insurers Must Respond within 7 Days or Face Ex Parte Orders from Insurance Ombudsman: IRDAI

Moneylife Digital Team 31 July 2026

Personal Finance

In a significant move aimed at reducing delays in the disposal of insurance complaints, the insurance regulatory and development authority of India (IRDAI) has directed insurers to strictly adhere to timelines for submitting documents to insurance ombudsman offices, warning that failure to comply could result in ex parte decisions based on the available records.

The regulator has asked insurers to submit self-contained notes (SCNs) along with all supporting documents within seven days of receiving a notice from the insurance ombudsman. Any additional information or documents sought subsequently must be furnished within three days.

The IRDAI circular, issued last week, also instructs insurers to submit all required information and documents in 'one go' instead of sending them in a piecemeal manner, a practice that the regulator said has been contributing to delays in resolving policyholder complaints.

Further, IRDAI has directed insurers to clear all pending requests for SCNs, additional information and documents from insurance ombudsman offices within 30 days from the date of the circular. This effectively gives insurers until 22 August 2026 to comply.

The most significant provision in the circular empowers insurance ombudsman offices to proceed with cases ex parte if insurers fail to comply with these directions.

IRDAI said that where an insurer does not submit the required documents within the stipulated timelines, the concerned ombudsman office shall decide the matter based on the material available on record without any further delay, to comply with the timelines prescribed under the Insurance Ombudsman Rules, 2017.

The move is expected to discourage insurers from delaying proceedings by withholding or submitting documents in instalments.

The regulator said the directions are issued after interactions with insurance ombudsmen during a recent orientation programme revealed 'inordinate delays' by insurers in submitting self-contained notes-SCNs, supporting documents and additional information.

It also noted that insurers often provide follow-up documents piecemeal, resulting in delays in the disposal of complaints filed by policyholders and beneficiaries.

According to IRDAI, the timely submission of documents is essential for ombudsmen to examine complaints and deliver decisions within the 90-day period envisaged under the Insurance Ombudsman Rules, 2017.

The circular is likely to provide relief to policyholders who have frequently complained about delays in ombudsman proceedings. By fixing clear deadlines for insurers and permitting ex parte decisions in cases of non-compliance, IRDAI has sought to improve the efficiency of the insurance ombudsman system and ensure quicker resolution of consumer grievances.

The regulator said the directions have been issued with the approval of the competent authority and are applicable to all insurers except reinsurers.

Comments

User

ashokmgk

2 weeks ago

They delay resolving without any valid reason, they have reduced my cumulative bonus unilaterally without any claim from 2009 .

hemantshah.cfp

2 weeks ago

I hope it is seriously implemented. Moreover whatever is submitted by insurance company is to be shared with complainant which is not happening now. In the interest of justice, the complainant should get opportunity to reply to the submission by insurance companies. At present some of the insurance companies do not bother to make any submission but at the time of final hearing their representative from legal team would argue some new points about which complainant is not aware and not in a position to reply instantly since complainant is not allowed to represent through legal assistance or even through agent. But in the other hand insurance companies can represent themselves through legal team.
If you want to know about more illegality in system you may contact me.

tejinder1962

Replied to hemantshah.cfp comment 2 weeks ago

I am in agreement to this very valid point ??

s.h

2 weeks ago

What does a Customer (Policy Holder) do when the Insurance Ombudsman is not reachable on phone / mobile / address given on the Insurer portal to address their grievance ?

My Client faced this situation with Care Health Insurance - whose customer service is the most pathetic I have experienced on several occasions. In fact even their broker : Probus Insurance Brokers are equally poor on customer service.

Then finally when we made them famous on social media, they responded and paid the pending claims to try and salvage their broken reputation online.

tejinder1962

Replied to s.h comment 2 weeks ago

Yes this one sided communication. They can contact the insured but not the other way around. I had filed two claims in a span of 2 days. They heard only one case and the other they forgot. For this I had to personally visit their office.

tejinder1962

3 weeks ago

It is a significant movement move and will help insured to get their legimate claims timely. For every order passed by ombudsman in favour of the insured a penalty or fine of minimum Rs.5000 should be imposed for inconvenience to the insured.

hindushare

3 weeks ago

Every goods & service has grievances.
License issuance by the regulator will have grievances too.
Hope the regulator also sets up a grievance mechanism with a defined TAT for this.

sajalg

3 weeks ago

Interest and penalties on insurance companies are way too low in india as compared to estern countries.. our regulators are soft on insurance companies.. this needs to be changed . There shud be exemplary fines and penalties if there is illogical denial or delay by insurance cos . Did we hear any such fines against them.. no... Regulators love them.. they don't bite them...

hemantshah.cfp

Replied to sajalg comment 2 weeks ago

Interest and penalty are not just low. But as per the guidelines ombudsman does not have power to grant any penalty or compensation. They cannot even grant interest in spite of interest clause is part of the policy. Much more reforms with regards to consumer grievances required.