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:
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The peril is not being covered. This means that the incident that happened is not covered under the policy
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Exclusion clauses in the policy for your specific problem. This means that the damage that occured is excluded from your policy
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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)
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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:
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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
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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.
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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
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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.
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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.
Federal Insurance Ombudsman
The Insurance Ombudsman falls under the ambit of the Federal Ombudsman and works to safeguard the interests of policyholders and settle any grievances of policyholders.
The Federal Insurance Ombudsman was formed under the Insurance Ordinance, 2000. The emphasis of the Insurance Ordinance is to control the business of the insurance industry to guarantee the welfare of insurance policyholders. The rights and authority of the Federal Insurance Ombudsman were strengthened under the Federal Ombudsmen Institutional Reforms Act, 2013.
The aim is to grow a modern and wide-ranging monitoring system based on equitable principles to notice any maladministration in Pakistan’s Insurance Industry and offer impartial security of interest of all the Stakeholders in the Insurance Industry.
Federal Insurance Ombudsman is offering timely justice to any affectee clients against maladministration of the Insurance Companies. They provide assistance to any distressed policyholders according to the essence of Insurance Ordinance, 2000 and Federal Ombudsmen Institutional Reforms Act, 2013.
The authority of the Federal Insurance Ombudsman is spread all over Pakistan to facilitate its main role to relieve any mistreated insurance policyholders from anywhere in Pakistan. The office makes full efforts to address all the complaints of policyholders about any genuine maladministration of Insurance Companies that is sent to them.
Based on the increasing numbers of complaints filed against Insurance Companies from all over Pakistan, the Federal Insurance Ombudsman has created Regional Offices in Islamabad, Lahore, Multan, Peshawar, Quetta, and Sukkur at Hyderabad and functioning.
Then the policyholder has certain readily available recourse mechanisms. Some of the steps are mentioned below:
The policyholder can write to the insurance company regarding their grievance while mentioning the intention to file a complaint with the office of the insurance ombudsman;
If the insurance company does not give a satisfactory reply within one month, the policyholder can submit an application with the office of the Insurance Ombudsman in three months.
A complaint is required to be made on solemn affirmation or oath in writing addressed to the Insurance Ombudsman. The complaint shall set out the full particulars of the complaint matter and the name and address of the complainant.
To contact the offices of the Insurance Ombudsman, policyholders may contact the address below:
FEDERAL INSURANCE OMBUDSMAN
2nd Floor, Pakistan Red Crescent Society
Annexe Building, and Plot # 197/5
Dr. DoudPota Road
Karachi.
Phone: 021-99207761-62
Website: www.fio.gov.pk
Official Coordinator, Small Dispute Resolutions Committee(Islamabad)
The Management Executive, Insurance Division,
3rd Floor, NIC Building, 63- Jinnah Avenue,
Blue Area, Islamabad.
Phone: 051-9207091-4 ext 439
Email: complaints@secp.gov.pk
* Policyholders from Islamabad Capital Territory, Khyber Pakhtunkhwa, Gilgit Baltistan, Azad Jammu and Kashmir, Bhakkar, Khushab, Mianwali, Jhelum, Chakwal, Rawalpindi, and Attock, AJK/Gilgit Baltistan can approach FIO
Official Coordinator, Small Dispute Resolutions Committee(Karachi)
The Deputy Director, Specialized Companies Division, 5th Floor, State Life Building No. 2,
Wallace Road, Off. I.I. Chundrigar Road, Karachi.
Phone: 021-32414204
Email: complaints@secp.gov.pk
* Policyholders from Sind and Balochistan may approach this committee
Official Coordinator, Small Dispute Resolutions Committee(Lahore)
The Deputy Registrar of Companies, Company Registration Office – Lahore, Associate House,
3rd and 4th Floor, 7 – Egerton Road, Lahore.
Phone: 042-99204962-66 ext: 28
Email: complaints@secp.gov.pk
*Policyholders from all districts of Punjab except for Bhakkar, Khushab, Mianwali, Jhelum, Chakwal, Rawalpindi, and Attock may approach this committee
Sadia Zaheer holds a Masters in Business Administration from IBA, Karachi. After working in several financial institutions in Client Management, Corporate Lending, Islamic Banking and Product Management she jumped careers to pursue a career in writing.
She is a Finance, Business and HR Development writer with four years of experience. She reads a lot and takes care of her multiple cats to remain calm.
