How to apply / make a complaint to The Ombudsman
We would advise a policy holder who wishes to apply to the Insurance Ombudsman for relief to consult this website which has been prepared by the Ombudsman for the benefit of the public. It contains useful information to those wishing to apply to the Ombudsman and generally about the Ombudsman scheme.
There are two main steps you have to consider when seeking any relief from the Insurance Ombudsman.
Step 01
Ask yourself whether you have contacted the insurance company that sold you the policy about your complaint. For example, your car has met with an accident and the insurance company is refusing or not paying the entire repair bill claimed by you. Have you written to or spoken to a responsible officer of the insurer about it?. Has the insurer failed to respond or failed to attend to your complaint to your satisfaction. It is only at this stage that you should complain to the Insurance Ombudsman. Please avoid complaining to the Insurance Ombudsman without first attempting to resolve your dispute with the insurer.
Step 02
Let us assume you have tried to contact the insurance company but (i) you either had no response or (ii) the insurance company was unwilling or unable to satisfy your complaint. If you still feel that you have a grievance that needs to be redressed, you can apply to the Insurance Ombudsman.
No special application forms
Applying to the Insurance Ombudsman is simple. There are no special forms to fill up. All that you have to do is to write out your complaint in any language of your choice.(English or Sinhala) and post it/fax it or deliver it to the Ombudsman’s Office. The Ombudsman will not entertain telephone complaints and/or unsigned complaints.
What facts must you give
Please state clearly your name and address and other contact details(such as Telephone/Fax numbers if available) and give a brief account of your grievance/complaint. Do not fail to mention the name of the insurance company and the insurance policy number. If the complaint refers to a motor vehicle, please give the vehicle number.
Do not send/post any documents(such as the insurance policy etc.) to the Ombudsman. The Ombudsman’s office will obtain all the necessary documents from the insurer.
What happens after you apply to the Ombudsman
On the receipt of your written complaint, the Ombudsman’s office will contact the insurer and ask for an early response. If the complaint/dispute can be settled without calling for an inquiry or asking the complainant to attend the Ombudsman’s Office the Ombudsman will do so without troubling you. If not, the Ombudsman will hold an inquiry after informing you (the complainant) so that you can attend the inquiry.
After the inquiry, the Ombudsman will take a decision of which you will be informed.
The above steps will not take long and you will always be kept informed.
The Ombudsman is a user-friendly inexpensive scheme
On our website, we referred to three steps a policyholder should take before complaining to the Ombudsman. We also referred to special application forms on which to apply and provided specimen forms on our website. All these forms are no longer required and the steps that you may take and the simple way to apply to the Ombudsman are the steps now set out above.
In the first year of this scheme, the Ombudsman has made it a very simple/ user-friendly scheme where policyholders who seek relief are not expected or required to spend any money or expenses in seeking relief from the Ombudsman. Please always remember that the Insurance Ombudsman Scheme is a free scheme and there is no charge of any kind to apply to the Ombudsman.
