Insurance Ombudsman (Mohtasib) in Pakistan: All you need to know

When you buy an insurance policy for your car, travel, or health, the purpose is to ensure that you get your claim accepted and processed whenever something unpleasant happens. This is the primary purpose of getting an insurance policy. If quick and convenient claim processing does not occur, the purpose of buying insurance is wasted.  For instance, there is no point in paying insurance premiums (on time) for your car insurance if you are not getting your accident claim processed and paid on time.

There are some instances where the insurance company says that it is not liable to pay for your losses and gives reasons like:

• The peril is not being covered. This means that the incident that happened is not covered under the policy

• Exclusion clauses in the policy for your specific problem. This means that the damage that occured is excluded from your policy

• Payment limit or restriction in paying etc. This means that you have reached a cap of claims possible (when you have not claimed so many)

• It takes longer than stated to process the claim.

Provided that there is no lacking in the insurance documentation, or non-payment of premiums from your end, you can file a complaint with the Insurance Ombudsman, also called the Wafaqi Muhtasib in any of the scenarios listed above.

However, before you complain to the Insurance Ombudsman, you must make sure that you have done all of the following:

1. Written to the insurance company about your complaint and clearly mentioned that you plan to file a complaint with the office of the Insurance Ombudsman. There should also be written/emailed proof of communication with regional heads of the insurance company to ensure that a responsible higher up was aware of the issue from the insurance company’s

2. If you don’t get a satisfactory response from the insurance company in a period of one month, you can raise your complaint to the office of the Insurance Ombudsman. This must be done within three months of your communication with the insurance company.

The Insurance Ombudsman is an independent national body formed to settle insurance disputes between policyholders and their issuing companies. The dispute resolution is done without fees and independently and impartially.

1. Written to the insurance company about your complaint and clearly mentioned that you plan to file a complaint with the office of the Insurance Ombudsman. There should also be written/emailed proof of communication with regional heads of the insurance company to ensure that a responsible higher up was aware of the issue from the insurance company’s

2. If you don’t get a satisfactory response from the insurance company in a period of one month, you can raise your complaint to the office of the Insurance Ombudsman. This must be done within three months of your communication with the insurance company. The Insurance Ombudsman is an independent national body formed to settle insurance disputes between policyholders and their issuing companies. The dispute resolution is done without fees and independently and impartially.

3. Your complaint will be needed in writing with a ‘solemn affirmation’ or oath addressing the Insurance Ombudsman. The complaint should give all details of your complaint and have your name and address. The website of the Insurance ombudsman has links to complaint forms and affidavits that need to be signed.

Federal Ombudsman

The Insurance Ombudsman works under the umbrella of the Federal Ombudsman of Pakistan, known as the Wafaqi Mohtasib.

Wafaqi Mohtasib’s (Ombudsman) office was formed in 1983 under a Presidential Order. The main responsibilities of the Wafaqi Mohtasib are to identify, examine, make amends where necessary, and correct any wrong done to any member of the public through malpractice, inefficiency, or maladministration of any agency of the Federal Government.

The Mohtasib has a wide area of responsibility to investigate all affairs of the Federal Government. A department of the Federal Ombudsman Office is the Federal Insurance Ombudsman, which handles matters related to insurance issues.