**Executive Summary**
The Insurance Regulatory and Development Authority of India (IRDAI) has released the Exposure Draft of the Internal Insurance Ombudsman Guidelines, 2025, for public consultation. These guidelines aim to establish an independent review mechanism within insurance companies to address unresolved complaints fairly and transparently. Stakeholders are invited to submit comments and suggestions by 5:00 PM on 17th August, 2025.
**Key Points / Main Content**
* **Purpose:**
* Enhance policyholder protection and trust in the insurance ecosystem.
* Improve grievance redressal.
* **Establishment of Internal Insurance Ombudsman:**
* Mandates a fair, transparent, and time-bound mechanism for handling unresolved or escalated complaints.
* Requires all insurers (except reinsurers) with over three years of operations to appoint an Internal Insurance Ombudsman.
* The Ombudsman will handle complaints related to claims up to ₹50 lakh.
* Insurers may appoint multiple Ombudsmen with well-defined jurisdictions.
* **Guidelines for Internal Insurance Ombudsman:**
* Comprehensive guidelines define eligibility criteria, tenure, independence, role, responsibilities, and remuneration structure.
* Outlines general principles to be followed.
* **Reporting Structure:**
* Functionally reports to the Board or its Policyholder Protection, Grievance Redressal and Claims Monitoring Committee.
* Administratively reports to the MD/CEO.
**Impact Analysis**
**Insurers**
* **Impact**
* Required to establish an internal, independent review mechanism.
* Required to appoint an Internal Insurance Ombudsman or multiple Ombudsmen, meeting specific criteria.
* Must adhere to defined guidelines for eligibility, tenure, independence, role, and remuneration.
* **Action Required**
* Review the Exposure Draft of the Internal Insurance Ombudsman Guidelines, 2025.
* Provide comments and suggestions to IRDAI by 5:00 PM on 17th August, 2025.
* Prepare for the implementation of the guidelines if they are approved.
**Policyholders**
* **Impact**
* Will benefit from a more robust and transparent grievance redressal mechanism.
* Increased confidence in the insurance sector through improved handling of complaints.
* **Action Required**
* Review the Exposure Draft of the Internal Insurance Ombudsman Guidelines, 2025.
* Provide comments and suggestions to IRDAI by 5:00 PM on 17th August, 2025.
**IRDAI**
* **Impact**
* Further enhances the quality of grievance handling and overall consumer confidence in the insurance sector.
* **Action Required**
* Review stakeholder feedback and finalise the Internal Insurance Ombudsman Guidelines, 2025.
Key Entities Referenced
Internal Insurance Ombudsman Guidelines, 2025: Draft guidelines issued by IRDAI proposing an independent review mechanism within insurance companies to address unresolved complaints.
Insurance Regulatory and Development Authority of India (IRDAI): The regulator that issued the Internal Insurance Ombudsman Guidelines, 2025.
Policyholder Protection, Grievance Redressal and Claims Monitoring Committee: A committee to which the Internal Insurance Ombudsman functionally reports to.
भारतीय बीमा िविनयामक और िवकास प्रािधकरण
Insurance Regulatory and Development Authority of India
प्रेस िवज्ञ�� | 23 जुलाई 2025
PRESS RELEASE | 23rd JULY 2025
आंत�रक बीमा लोकपाल िदशािनद�श, 2025 का ए�पोज़र ड�ा�
Exposure Draft of Internal Insurance Ombudsman Guidelines, 2025
िशकायतों के समाधान और पािलसीधारक के िव�ास को बढ़ाने की ओर एक कदम
A Step Towards Enhancing Grievance Redressal and Policyholder Trust
पािलसीधारको ं के संरक्षण को मजबूत करने एवं बीमा पा�र��ितक तंत्र (ईकोिस�म) में िव�ास को
बढ़ाने के अपने िनरंतर प्रयास के भाग के रूप में भारतीय बीमा िविनयामक और िवकास प्रािधकरण
(आईआरडीएआई) ने आंत�रक बीमा लोकपाल िदशािनद�श, 2025 का ए�पोज़र प्रारूप सावर्जिनक
परामशर् के िलए जारी िकया है।
उ� िदशािनद�शो ं का प्रारूप, समाधान न की गई अथवा उ�तर �र पर ले जाई गई िशकायतो ं का
समाधान एक उिचत, पारदश� और समयबद्ध तरीके से करने के िलए बीमा कं पिनयो ंके अंदर एक �तंत्र
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कायार्विध से यु� सभी बीमाकतार्ओ ं के िलए (पुनब�माकतार्ओ ं को छोड़कर) लागू उ� रूपरेखा रु.50
लाख तक के दावो ं से संबद्ध िशकायतो ं का समाधान करने के िलए एक आंत�रक बीमा लोकपाल की
िनयु�� को अिनवायर् (मैंडेटरी) करती है। बीमाकतार् प्रभावी कवरेज और अनुिक्रयाशीलता को सुिनि�त
करने के िलए सुप�रभािषत क्षेत्रािधकार से यु� एक से अिधक आंत�रक बीमा लोकपालो ं की िनयु��
भी कर सकते हैं।
उ� िदशािनद�श आंत�रक बीमा लोकपाल द्वारा अनुसरण िकये जानेवाले सामा� िसद्धांतो ंके साथ ही,
�ापक रूप से पात्रता मानदंड, कायर्काल, �तंत्रता, भूिमका व दािय� तथा पा�रश्रिमक संरचना
िनधार्�रत करते हैं। सुदृढ़ अिभशासन और िनगरानी को प्रबिलत करने के िलए यह प्र�ािवत है िक
आंत�रक बीमा लोकपाल कायार्�क तौर पर बोडर् या उसकी पािलसीधारक संरक्षण, िशकायत
िनवारण और दावा िनगरानी सिमित को तथा प्रशासिनक तौर पर प्रबंध िनदेशक/सीईओ को
�रपोटर् करेगा।
इस आंत�रक परंतु �तंत्र �व�ा को सं�ा का रूप देने के द्वारा आईआरडीएआई िशकायतो ंके प्रबंध
की गुणव�ा में आगे और सुधार लाने तथा बीमा क्षेत्र में समग्र उपभो�ा िव�ास में वृ�द्ध करने का ल�
रखता है। यह ए�पोज़र प्रारूप आईआरडीएआई की वेबसाइट (www.irdai.gov.in) पर उपल� है
तथा िहतधारको ं को आमंित्रत िकया जाता है िक वे अपनी िट�िणयाँ और सुझाव 17 अग� 2025 को
अपराह्न 5.00 बजे तक प्र�ुत करें।As part of its continued endeavour to strengthen the policyholder protection and enhance trust
in the insurance ecosystem, the Insurance Regulatory and Development Authority of India
(IRDAI) has released the Exposure Draft of the Internal Insurance Ombudsman Guidelines,
2025 for public consultation.
The draft guidelines propose the establishment of an independent and impartial review
mechanism within insurers to address unresolved or escalated complaints in a fair, transparent,
and time-bound manner. Applicable to all insurers (except reinsurers) with more than three
years of operations, the framework mandates the appointment of an Internal Insurance
Ombudsman to address complaints involving claims up to ₹50lakh. Insurers may also appoint
more than one Internal Insurance Ombudsman, with well-defined jurisdiction, to ensure
effective coverage and responsiveness.
The guidelines comprehensively lay down the eligibility criteria, tenure, independence, role &
responsibilities and remuneration structure of Internal Insurance Ombudsman along with
general principles to be followed by the Internal Insurance Ombudsman. To reinforce strong
governance and oversight, it is proposed that the Internal Insurance Ombudsman shall
functionally report to the Board or its Policyholder Protection, Grievance Redressal and Claims
Monitoring Committee, with administrative reporting to the MD/CEO.
By institutionalizing this internal but independent mechanism, IRDAI aims to further improve
the quality of grievance handling and enhancing overall consumer confidence in the insurance
sector. The exposure draft is available on the IRDAI website (www.irdai.gov.in), and
stakeholders are invited to submit their comments and suggestions by 5:00 PM on 17th August,
2025.
आर के शमार् / R K Sharma
मु� महाप्रबंधक / Chief General Manager