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| Addressing a press conference G Krishnamurthy, Insurance Ombudsman (Maharashtra and Goa) said, " Non-life insurance accounts for about 75 per cent of the total complaints filed and Mediclaim contributes the major junk of about 65 per cent of the cases filed for."
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| Krishnamurthy said, "The reason behind large number of cases filed for Mediclaim is because of the pre-existing disease clause in the policy. The pre-existing clause is the much debated issue between the insurance company and the insurance policy holder."
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| He pointed out that the awareness among the public to approach the Insurance Ombudsman for complaints against settlement of insurance claims is very low.
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| "Though there the ratio of complaints settled is in favour of the consumer is as high as 67 per cent and 33 per cent in favour of insurance companies in Chennai," he said.
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| The Insurance Ombudsman settles disputes relating to partial or total repudiation of claim, delay in settlement of claims, interpretation of policy terms in relation to claims, disputes regarding premium paid or payable in terms of the policy and non-issuance of insurance documents.
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| A policy holder can file complaints for life as well as non-life insurance with the Insurance Ombudsman for an amount not exceeding Rs.20 lakh.
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| The settlement of the complaint by Insurance Ombudsman binds the insurance company while the policy holder can further approach a consumer forum or the civil court.
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| There are about 12 Ombudsman offices throughout India like Delhi, Chandigarh, Lucknow, Kolkata, Guwahati, Bhubaneswar, Chennai, Hyderabad, Kochi, Bhopal, Ahmedabad, Kochi, Bhopal, Ahmedabad and Mumbai.
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| The total number of complaints received by the Chennai office was 288 of which 262 complaints were disposed in the life insurance segment.
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| In the non-life insurance side the number of complaints filed were 293 and number of complaints settled were 216. All India Insurance Ombudsman received a total number of 3,898 complaints of which 2,497 complaints were disposed in the non-life insurance category.
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| Complaints filed under the life insurance category amounted to 2,481 of which 1,917 complaints were disposed. |
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