(1)Any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee, make a complaint in writing to the Insurance Ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential address or place of residence of the complainant is located.(2)The complaint shall be in writing, duly signed by the complainant or through his legal heirs, nominee or assignee and shall state clearly the name and address of the complainant, the name of the branch or office of the insurer against whom the complaint is made, the facts giving rise to the complaint, supported by documents, the nature and extent of the loss caused to the complainant and the relief sought from the Insurance Ombudsman.(3)No complaint to the Insurance Ombudsman shall lie unless-(a)the complainant makes a written representation to the insurer named in the complaint and-(i)either the insurer had rejected the complaint; or(ii)the complainant had not received any reply within a period of one month after the insurer received his representation; or(iii)the complainant is not satisfied with the reply given to him by the insurer;(b)The complaint is made within one year-(i)after the order of the insurer rejecting the representation is received; or(ii)after receipt of decision of the insurer which is not to the satisfaction of the complainant;(iii)after expiry of a period of one month from the date of sending the written representation to the insurer if the insurer named fails to furnish reply to the complainant .(4)The Ombudsman shall be empowered to condone the delay in such cases as he may consider necessary, after calling for objections of the insurer against the proposed condonation and after recording reasons for condoning the delay and in case the delay is condoned, the date of condonation of delay shall be deemed to be the date of filing of the complaint, for further proceedings under these rules.(5)No complaint before the Insurance Ombudsman shall be maintainable on the same subject matter on which proceedings are pending before or disposed of by any court or consumer forum or arbitrator.
