Date: 2021-03-02 Category: Extra Ordinary State: Union Government Country: India

Whereas, certain draft rules namely the Insurance Ombudsman Amendment Rules, 2020, were published

Issued by Ministry of Finance · Department of Financial Services

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Executive Summary & Key Takeaways

                    **Report on the Insurance Ombudsman Amendment Rules, 2021**

**1. Executive Summary:**

This report analyzes the Insurance Ombudsman Amendment Rules, 2021, as published in the Gazette of India on March 2, 2021. These rules amend the Insurance Ombudsman Rules, 2017. The core purpose of these amendments is to broaden the scope of the Ombudsman scheme, enhance the selection process for Insurance Ombudsmen, and modernize complaint handling procedures. Key changes include the inclusion of insurance brokers within the scheme's purview, revisions to the selection criteria and terms for Insurance Ombudsmen, and the introduction of a complaints management system.

**2. Introduction:**

This report aims to provide an informative overview of the Insurance Ombudsman Amendment Rules, 2021, based solely on the provided policy text. It outlines the amendments' objectives, key changes, affected stakeholders, and expected outcomes, offering a concise analysis for understanding the implications of these regulatory updates.

**3. Policy Overview:**

*   This document amends the Insurance Ombudsman Rules, 2017.
*   **Core Objective(s):** Based on the text, the core objectives of these amendments appear to be:
    *   To expand the scope of the Insurance Ombudsman scheme to include insurance brokers.
    *   To refine the selection process, qualifications, and terms of office for Insurance Ombudsmen.
    *   To modernize and enhance the complaint resolution process, including the use of technology.

**4. Background and Rationale:**

The amendments likely address the need to:

*   **Include Insurance Brokers:** Resolve disputes involving insurance brokers, previously outside the explicit purview of the Ombudsman scheme.
*   **Strengthen Ombudsman Selection:** Improve the selection process for Insurance Ombudsmen to ensure competence, integrity, and absence of conflicts of interest. This aims to enhance the credibility and effectiveness of the scheme.
*   **Enhance Complaint Handling:** Modernize the complaint handling process through an online platform and videoconferencing, thereby improving accessibility and efficiency.

**5. Key Provisions / Changes:**

The following are the key changes introduced by the Insurance Ombudsman Amendment Rules, 2021:

*   **Inclusion of Insurance Brokers:** The amendments extend the jurisdiction of the Insurance Ombudsman to include complaints against insurance brokers (Rules 10, 11, 12, 13, 17). This change means that policyholders can now file complaints against insurance brokers for deficiencies in service, similar to how they could against insurers.
*   **Substitution of Terms:** The terms "IRDAI" is replaced with "Authority", and "Executive Council of Insurers" is replaced with "Council for Insurance Ombudsmen" (Rule 2).
*   **Revised Definition of "Council for Insurance Ombudsmen":** The definition of "Council for Insurance Ombudsmen" is updated to reflect its role in the new framework (Rule 3).
*   **Selection Committee for Appointment of Insurance Ombudsman:** Rule 7 is substituted to detail the composition and process of the Selection Committee responsible for appointing Insurance Ombudsmen. The committee includes representatives from the Authority, Banks Board Bureau, Central Government, and consumer protection advocates. The process involves advertisement of vacancies, shortlisting of candidates based on service length, scrutiny by the Authority for suitability and conflict of interest, vigilance clearance, and interaction with candidates. This aims to enhance the transparency and rigor of the selection process (Rule 5).
*   **Qualification and Procedure for Ombudsman Appointment:** New rules 7A and 7B specify the qualifications for becoming an Insurance Ombudsman and the procedure for selection (Rule 5). Qualifications now include age limits, experience in civil service or the insurance industry, and absence of conflicts of interest. The procedure involves shortlisting candidates, obtaining opinions from the Authority, vigilance clearances (where applicable), and recommendations from the Selection Committee.
*   **Term of Office:** Rule 8 is substituted to specify the term of office as three years or until the age of sixty-eight, with no reappointment eligibility. An exception is made for current Ombudsmen who may continue until their initially specified term or the age of seventy (Rule 6).
*   **Grounds for Removal:** Rule 9 is amended to include additional grounds for removal, such as physical incapacity, unsoundness of mind, insolvency, conviction for offences, conflict of interest, or providing false information during selection (Rule 7).
*   **Vacancy Provisions:** Rule 11 is amended to allow the Council for Insurance Ombudsmen to authorize another Ombudsman to discharge the functions of a vacant office for up to six months or until the vacancy is filled (Rule 8).
*   **Definition of Deficiency:** The explanation for Rule 13 now includes the meaning as assigned to it in clause 11 of section 2 of the Consumer Protection Act, 2019 (Rule 9).
*   **Complaint Submission:** Rule 14 is amended to allow complaints to be signed or made via electronic mail or online (Rule 10). A complaints management system, including an online platform, is mandated.
*   **Videoconferencing:** Rule 15 is amended to allow Ombudsmen to conduct hearings via videoconference, subject to guidelines (Rule 11).

**6. Target Audience and Stakeholders:**

*   **Policyholders:** The ultimate beneficiaries, as they gain expanded avenues for resolving grievances.
*   **Insurers:** Subject to the rulings of the Insurance Ombudsman.
*   **Insurance Brokers:** Now explicitly included within the scope of the Ombudsman scheme.
*   **Council for Insurance Ombudsmen:** Responsible for implementing and overseeing the scheme.
*   **Authority (IRDAI):** Involved in providing opinions on candidate suitability for Ombudsman positions.
*   **Selection Committee:** Responsible for recommending candidates for Insurance Ombudsman positions.
*   **Central Government:** Involved in nominating members to the Selection Committee and providing vigilance clearances.

**7. Implementation Aspects (Inferred):**

*   **Responsible Agency/Bodies:** The Council for Insurance Ombudsmen is responsible for implementing these amendments, including establishing the selection committee, appointing Insurance Ombudsmen, and developing the complaints management system. The Authority (IRDAI) plays a role in vetting candidates for suitability.
*   **Timelines/Procedures:** The amendments require the Council to advertise vacancies for Insurance Ombudsmen at the beginning of each calendar year and establish a selection process. They also mandate the development of an online complaints management system.
*   **Specific to the Changes:** The Council must establish the selection committee according to the new composition, develop a process for assessing candidate suitability in conjunction with the Authority, and implement the vigilance clearance process for relevant candidates. The online complaints management system will need to be designed to accommodate complaints against insurance brokers as well as insurers.

**8. Expected Outcomes / Impact of Changes:**

The likely intended outcomes of these amendments are:

*   **Enhanced Consumer Protection:** Expanding the scope to include insurance brokers and modernizing the complaint process should provide policyholders with a more accessible and efficient means of redress.
*   **Improved Ombudsman Quality:** Stricter selection criteria and a defined term of office are expected to lead to a more competent and impartial cohort of Insurance Ombudsmen.
*   **Increased Transparency:** The formalized selection process and the complaints management system should improve transparency and accountability within the Ombudsman scheme.

**9. Conclusion:**

The Insurance Ombudsman Amendment Rules, 2021, represent a significant update to the regulatory framework governing insurance dispute resolution in India. By extending the scheme's scope to include insurance brokers, refining the selection process for Ombudsmen, and modernizing complaint handling procedures, these amendments aim to enhance consumer protection and improve the overall effectiveness of the Insurance Ombudsman scheme. The changes reflect a commitment to adapting the regulatory framework to address evolving industry practices and policyholder needs.
                

Key Entities Referenced

Delhi: Location of the Controller of Publications. Insurance Ombudsman Amendment Rules, 2020: Draft rules published in the Gazette of India. Ministry of Finance: The ministry responsible for the Department of Financial Services. Department of Financial Services: A department within the Ministry of Finance. New Delhi: Location where the notification was issued. Insurance Regulatory and Development Authority Act, 1999: Act that confers powers to the Central Government for amending Insurance Ombudsman Rules. Insurance Ombudsman Rules, 2017: The rules being amended by this notification. Insurance Ombudsman Amendment Rules, 2021: The new rules resulting from this notification. Executive Council of Insurers: Replaced by the term 'Council for Insurance Ombudsmen'. Council for Insurance Ombudsmen: Entity constituted under rule 5, responsible for appointing Insurance Ombudsman. Selection Committee: Committee for recommending candidates for Insurance Ombudsman. Banks Board Bureau: Autonomous body set up by the Central Government for selection of wholetime directors of public sector insurance companies. Central Government: Government body responsible for selection of nonofficial member in the selection committee Central Vigilance Commission Act, 2003: Act under which the Central Vigilance Commission was established. Directorates of Enforcement: Agency which provides reports on any inquiry or investigation or proceeding instituted against a candidate. Revenue Intelligence: Agency which provides reports on any inquiry or investigation or proceeding instituted against a candidate. Goods and Service Tax Intelligence: Agency which provides reports on any inquiry or investigation or proceeding instituted against a candidate. Central Board of Direct Taxes: Agency which provides reports on any inquiry or investigation or proceeding instituted against a candidate. Consumer Protection Act, 2019: Act defines the term deficiency. Saurabh Mishra: Jt. Secy. (Joint Secretary) who signed the notification. Mayapuri, New Delhi: Location of the Dte. of Printing at Government of India Press.

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                रजजस्ट्री स.ं डी.एल.- 33004/99 REGD. No. D. L.-33004/99
xxxGIDHxxx
सी.जी.-डी.एलxx.x-GअID.-E0x2xx0 32021-225587
CG-DL-E-02032021-225587
असाधारण
EXTRAORDINARY
भाग II—खण्ड 3—उप-खण्ड (i)
PART II—Section 3—Sub-section (i)
प्राजधकार स ेप्रकाजित
PUBLISHED BY AUTHORITY
स.ं 106] नई ददल्ली, मगं लिार, माच च2, 2021/फाल्ग नु 11, 1942
No. 106] NEW DELHI, TUESDAY, MARCH 2, 2021/PHALGUNA 11, 1942
जित्त मत्रं लाय
(जित्त ीय सिे ाएं जिभाग)
अजधसचू ना
नई ददल्ली 2 माच,च 2021
सा.का.जन. 147(अ).—कजतपय प्रारुप जनयम, अथाचत ् बीमा लोकपाल (संिोधन) जनयम, 2020 भारत सरकार के
जित् त मंत्रालय, जित् तीय सेिाएं जिभाग कअ अजधसूचना सं‍य ा 788 (अ), तारीख 22 ददसंबर, 2020 द्वारा भारत के
राजपत्र, असाधारण, भाग II, खण्ड-3, उपखण्ड (i), तारीख 22 ददसंबर, 2020 में उन सभी व् यज‍त यस से, जजनका उसस े
प्रभाजित होना संभाव् य ह, उस तारीख स,े जजसको उ‍त अजधसूचना अंत्ि्‍ करन े िाल े राजपत्र कअ प्रजतया ं जनसाधारण
को उपलब् ध कराई गई थी, पैंतालीस ददिस कअ अिजध कअ समाज‍ त से पहले आक्षेप और सझु ाि आमंजत्रत करते हुए प्रकाजित
दकए गए थे ;
और, उ‍त राजपत्र कअ प्रजतयां जनसाधारण को 22 ददसंबर, 2020 को उपलब् ध कर दी गई थी ;
और, उ‍त प्रारुप जनयमस के संबंध में जनसाधारण से प्रा‍ त आक्षेपस और सझु ाि पर कें्ीय सरकार द्वारा जिचार कर
जलया गया ह ।
अत: अब कें्ीय सरकार, बीमा जिजनयामक और जिकास प्राजधकरण अजधजनयम, 1999 (1999 का 41) कअ धारा 24
द्वारा प्रदत् त िज‍त यस का प्रयोग करते हुए बीमा लोकपाल जनयम, 2017 (जजसे इसमें इसके पश् चात् उ‍त जनयम कहा गया
ह) का और संिोधन करन े के जलए जनम् नजलजखत जनयम बनाती ह, अथाचत ् :—
1. (1) इन जनयमस का संजक्ष‍ त नाम बीमा लोकपाल (संिोधन) जनयम, 2021 ह ।
(2) य ेराजपत्र म ें उनके प्रकािन कअ तारीख से प्रिृत् त हसगे ।
1316 GI/2021 (1)2 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
2. बीमा लोकपाल जनयम, 2017 म,ें —
(i) “आईआरडीएआई” िब् द, जहां-जहां िे आते ह,ैं के स्ट् थान पर “प्राजधकरण” िब् द रख ेजाएंग;े
(ii) “बीमाकता च कअ कायचकारी पररषद”् िब्द , जहां-जहां िे आत े ह,ैं के स्ट्थ ान पर, “बीमा लोकपाल पररषद” िब् द
रखे जाएंग े ।
3. उ‍त जनयमस के जनयम 4 के उपजनयम (1) म,ें —
(i) खंड (घ) के स्ट् थान पर जनम्न जलजखत खडं रखा जाएगा, अथातच ् :—
‘(घ) “बीमाकताच कअ कायचकारी पररषद” से जनयम 5 के अधीन गरित बीमा लोकपाल पररषद अजभप्रेत ह ;’
(ii) खंड (ङ) म ें“स्ट् थाजपत” िब्द के स्ट् थान पर, “जनयु‍त ” िब् द रखा जाएगा ;
(iii) खडं (च) का लोप दकया जाएगा ;
(iv) खडं ( ) के पश् चात् जनम्न जलजखत खडं अंत:स्ट् थाजपत दकया जाएगा, अथाचत ् :—
‘(ि) “बीमा दलाल” से ऐसा व् यज‍त अजभप्रते ह जजसे प्राजधकरण द्वारा बीमा दलाल के रुप में रजजस्ट् रीकरण
प्रमाणपत्र प्रदान दकया गया ह ;’।
4. उ‍त जनयमस के जनयम 5 के उपजनयम (2) के खंड (v) म,ें “जनदेिक” िब् द के स्ट्थ ान पर “संयु‍ त सजचि या
समतुल् य” िब् द रख ेजाएंग े ।
5. उ‍त जनयमस के जनयम 7 के स्ट् थान पर जनम्न जलजखत जनयम रखे जाएंग,े अथाचत ् :—
“7. बीमा लोकपाल कअ जनयुज‍त के जलए चयन सजमजत.— (1) बीमा लोकपाल पररषद इन जनयमस के अधीन
कतचव् यस और कृत् यस के जनिचहन के जलए ऐसी राज्य क्षेत्रीय अजधकाररता के जलए ऐसी सं‍ या में बीमा लोकपाल कअ
जनयुज‍त कर सकेगी जो बीमा लोकपाल पररषद जिजनर्दद्‍ करें ।”।
(2) बीमा लोकपाल, जनम्न जलजखत सदस्ट् यस स े जमलकर बनी चयन सजमजत कअ जसफाररिस पर बीमा लोकपाल
पररषद द्वारा जनयु‍त दकया जाएगा, अथातच ् :—
(क) प्राजधकरण का अध् यक्ष या प्राजधकरण का ऐसा अ्‍ य पूणकच ाजलक सदस्ट् य जजसे साधारण या जीिन
बीमा कारबार से संबंजधत मामले ्‍ यस्ट् त दकए गए ह ैंजो अध् यक्ष प्राजधकृत करे — अध् यक्ष;
(ख) बैंक बोड च ब् यरू ो के ग र-िासकअय सदस्ट् यस म ें से साधारण बीमा कारबार स े संबंजधत मामलस म ें
आिश् यक जििेष्ञतता और अनभु ि रखने िाला एक व् यज‍त — सदस्ट् य;
(ग) बैंक बोड च ब् यरू ो के गर -िासकअय सदस्ट् यस म ें से जीिन बीमा कारबार स े संबंजधत मामलस म ें आिश् यक
जििेष्ञतता और अनुभि रखन ेिाला एक व् यज‍त — सदस्ट् य;
(घ) एक व् यज‍त जजसका बीमा क्षेत्र में उपभो‍त ा अजधकारस को प्रो्‍ नत करने या उपभो‍त ा संरक्षण के
उद्देश् यस में अजभिृजका का र क ररकाडच हो — सदस्ट् य;
(ङ) जनयम 5 के उप जनयम (2) के खंड (v) में जनर्दद्‍ कें्ीय सरकार का एक प्रजतजनजध— सदस्ट् य
स्ट्प ्‍ ीकरण—इस उप जनयम में “बैंक बोडच ब् यूरो” पद से पजब् लक स ‍ र बीमा कंपजनयस के पूणचकाजलक
जनदेिकस के चयन के जलए कें्ीय सरकार द्वारा ऐसे नाम से स्ट्थ ाजपत स्ट् िायत जनकाय अजभप्रेत ह ।
(3) जहां उपजनयम (2) के खडं (ख) या खंड (ग) म ें जनर्दद्‍ ग र-िासकअय सदस्ट् य का पद रर‍त ह, कें्ीय
सरकार उ‍त खडं स म ें जनर्दद्‍ मामलस म ें ऐस े गर -िासकअय सदस्ट् य होन े के जलए पात्र अ्‍ य व्य ज‍त को चयन सजमजत
का सदस्ट् य होने के जलए नामजनर्दद्‍ कर सकेगी ।
(4) बीमा लोकपाल पररषद, बीमा लोकपाल के चयन के जलए जि्ञतापन द्वारा आिेदन आमंजत्रत करेगी और ऐसा
जि्ञतापन कलडैं र िष च के प्रारंभ पर बीमा लोकपाल कअ प्रत् येक जियमामान ररज‍त जजसके अंतगचत उस कलैंडर िषच म ें
उदभूत होने िाली कोई ररज‍त भी ह, के संबंध में जारी दकया जाएगा ।[भाग II—खण् ड 3(i)] भारत का राजपत्र : असाधारण 3
7क. बीमा लोकपाल कअ जनयुज‍त के जलए अहतच ा—कोई व् यज‍त बीमा लोकपाल के रुप म ें जनयुज‍त के जलए पात्र
नहीं होगा जब तक दक,—
(i) िह जि्ञतापन म ें आिेदन कअ प्राज‍ त के जलए जिजनर्दद्‍ अजं तम तारीख को पचपन िष च से कम ककत ु
पैंसि िषच से अजधक आयु का नहीं हो ;
(ii) िह अजखल भारतीय सेिा या संघ कअ जसजिल सेिा का सदस्ट् य नहीं ह या नहीं रहा ह और उसन े
भारत सरकार में संयु‍त सजचि या समतुल् य पद धारण नहीं दकया ह ; या
(iii) उसने बीमा उयमाोग में कम से कम पच् चीस िषच कअ सेिा नहीं कअ ह और बोड चमें जनदेिक से अ्‍ यून पद
धारण नहीं दकया ह ।
7ख. बीमा लोकपाल कअ जनयुज‍त के जलए प्रदिया—(1) बीमा लोकपाल पररषद, आिेदकस के संबंजधत प्रिग च म ें
उनकअ सेिा अिजध के आधार पर संगजणत पात्र आिेदकस में स े प्रत् येक ररज‍त के जलए, जनयम 7क के खंड (ii) और (iii)
में जिजनर्दद्‍ आिेदकस के प्रत् येक प्रिग चमें से पांच अ‍ य्थयस को चयजनत करेगी :
परंत ु जहां समान सेिा अिजध रखन े िाल े दो या अजधक अ‍ य्थयस के कारण चयजनत दकए जान े िाल े
अ‍ य्थयस कअ सं‍ या इस जनयम के अधीन जिजनर्दद्‍ सं‍ या से अजधक ह, ऐसी सेिा अिजध िाले सभी अ‍ यथथ
चयजनत सूची में सजम् मजलत दकए जाएंगे ।
स्ट्प ्‍ ीकरण—इस जनयम के प्रयोजनस के जलए दकसी आिेदक के संबंध में—
(i) जो अजखल भारतीय सेिा या संघ कअ जसजिल सेिा के सदस्ट्य के रुप म ें सेिारत ह या जजसनें सेिा कअ
ह, सेिा अिधी कअ गणना कें्ीय सरकार म ेंउनकअ भारत सरकार के संयु‍ त सजचि या समतल्ु य के रुप में पहली
जनयुज‍त कअ तारीख स ेकअ जाएगी, और
(ii) जज्‍ हसन े दकसी बीमा उयमाोग म ें सेिा कअ ह, सेिा अिधी कअ गणना बीमा उयमाोग म ें बोड च के जनदेिक
स्ट् तर के अव् यिजहत ्‍ यनू या बोडच के जनदेिक स्ट्त र पर प्रथम जनयुज‍त कअ तारीख से, जो भी पहले हो, कअ
जाएगी
(2) प्रत् येक चयजनत अ‍यथथ, ऐसी रीजत और प्ररुप म,ें जो बीमा लोकपाल पररषद जिजनर्दद्‍ करे, जनम्न जलजखत
जिजिज्‍ यां प्रस्ट् तुत करेगा, अथाचत् :—
(क) एक घोषणा और िचनबधं दक िह बीमा लोकपाल के कृत् यस और कतव्च यस के जनिचहन में जहतस के
कराि के न होने दने े को सुजनजश् चत करेंग;े और
(ख) जनम्न जलजखत के संबंध म ेंसूचना—
(i) व् यज‍त गत पहचान के ब् यौरे जजसके अंतगचत आय-कर स्ट् थायी खाता सं‍ या, बैंक खाता सं‍ या
और जनदेिक पहचान सं‍ या भी ह;
(ii) िृजत् तक इजतहास जजसके अतं गचत जनदेिक का पद धारण करना भी ह;
(iii) आपराजधक अजभयोजन के संबंध प्रक ीकरण, यदद कोई हो;
(iv) जित् तीय जहत जजसके अंतगतच अ‍ यथथ और उसके नातदे ारस का फायदाप्रद स्ट् िाजमत् ि भी ह;
(v) संगिन, जजससे िह संबंजधत हो ;
(vi) अ‍ यथथ या उसके नातेदारस के संबंध में प्रक ीकरण—
(क) जो उसके प्रितचक या जनदेिक या कमचचारी ह,
(ख) उनके साथ ताजत् िक धनीय संबंध रखते ह,
(ग) लेखा परीक्षक, कंपनी सजचि या लागत लेखाकार फमच या उसके साथ ताजत् िक
संव् यिहार रखन े िाली जिजधक या परामिथ फम चमें कमचचारी या स्ट् ित् िधारी या भागीदार ह, और4 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
(घ) जो दकसी अलाभकारी संगिन का मु‍य कायचकारी या जनदिे क ह, जजसके पास बीमाकताच
या उसकअ जनयंत्री, अनषु ंगी या सहायक कंपनी कअ ताजत् िक प्राज‍ तयां ह,
(vii) ऐसे अ‍यथथ या उसके नातेदारस के बारे म ें प्रक न, जो बीमाकताच में, दो प्रजतित से अजधक
िेयर धारण करते ह ैं या जो उसके सामग्री प्रदायकताच, सेिा प्रदाता या ग्राहक ह,ैं या जो उसके पट्टाकताच
या पट्टेदार ह ैं।
(3) लोकपाल बीमा पररषद,् उपजनयम (2) के अधीन, संप्रेजषत जानकारी और ऐसी अ्‍य जानकारी, जो िह
सुसंगत समझ,े को ध्यान म ें रखते हुए, आिेदक कअ उपयुक्तता, सत्यजनष्ठा और जहत कराि के अभाि के बारे में अपनी
राय के जलए जिजिजियां प्राजधकरण को संप्रेजषत करेगी ।
(4) उपजनयम (3) के अधीन प्राजधकरण कअ राय पर जिचार करन े के पश्चात्, उपजनयम (2) म ें जनर्ददि
अ‍य्थयस कअ जिजिजिया ं चयन सजमजत के समक्ष रखी जाएगी, जो अ‍य्थयस कअ उपयक्तु ता, जजसके अंतगचत जहतस के
कराि के अभाि के बारे म ें उपयुक्तता भी ह, पर जिचार करेगी और अ्‍यो्‍यदिया के जलए अ‍य्थयस कअ चयन सूची
कअ प्रदिया को अंजतम रूप देगी ।
(5) उपजनयम (4) के अधीन चयन सजमजत द्वारा अंजतम रूप दी गई चयन सूची में द्ित दकए जाने िाले ऐस े
अ‍य्थयस के संबंध म,ें जो कें्ीय सतकचता आयोग अजधजनयम, 2003 (2003 का 45) के अधीन स्ट्थाजपत कें्ीय
सतकचता आयोग कअ िजक्तयस और कृत्यस कअ पररजध के अंतगतच आन े िाले लोक सेिक या पदाजधकारी हैं, लोकपाल
बीमा पररषद,् जित्त मंत्रालय, जित्तीय सेिा जिभाग के माध्यम से सतकचता अनापजत्त प्राप्त करेगी ।
(6) उपजनयम (4) के अधीन चयन सजमजत द्वारा अंजतम रूप दी गई चयन सूची में द्ित दकए जाने िाले ऐस े
अ‍य्थयस के संबंध म,ें जो उपजनयम (5) म ें जनर्ददि लोक सेिकस या पदाजधकाररयस से जभन्न ह,ैं लोकपाल बीमा
पररषद,् उपजनयम (2) में जनर्ददि जानकारी, प्रितचन जनदिे ालय, राजस्ट्ि आसूचना तथा माल और सेिा कर आसूचना
को तथा कें्ीय प्रत्यक्ष कर बोड च को ऐसे अ‍यथथ के जिरुका संजस्ट्थत दकसी जांच या अ्‍िेषण या कायचिाही पर उनकअ
ररपो ों के जलए प्रस्ट्तुत करेगी ।
(7) चयन सजमजत, उपजनयम (4) के अधीन उसके द्वारा चयजनत सभी अ‍य्थयस को अ्‍यो्‍यदिया के जलए
अिसर प्रदान करने के पश्चात,् लोकपाल बीमा के कायाचलय में प्रत्येक ररजक्त के संबंध में जनयुजक्त के जलए, आरजक्षत
अ‍य्थयस के रूप में अजधमान के िम में दो अजतररक्त अ‍य्थयस सजहत, अ‍यथथ कअ जसफाररि करेगी ।
(8) लोकपाल बीमा पररषद,् उपजनयम (7) के अधीन चयन सजमजत कअ जसफाररिस पर जिचार करन े के पश्चात्,
दकसी अ‍यथथ कअ बीमा लोकपाल के रूप में जनयक्तु करने कअ जसफाररि तब तक नहीं करेगी, जब तक, —
(i) उपजनयम (5) के अधीन अपजे क्षत सतकचता अनापजत्त प्राप्त न हो गयी हो ; या
(ii) लोकपाल बीमा पररषद ् कअ यह राय ह दक इनपु कअ प्रकृजत ऐसी ह दक िह लोक जहत म ें नहीं होगी
दक उसे इस प्रकार जनयुक्त दकया जाए,
और ऐसे मामले में लोकपाल बीमा पररषद ्अजधमान के िम के अनुसार आरजक्षत अ‍यथथ पर जनयुजक्त के जलए जिचार
करेगी ।
(9) लोकपाल बीमा पररषद,् अ‍य्थयस कअ उपयुक्तता पर जिचार करन े के पश्चात्, दकसी अ‍यथथ को बीमा
लोकपाल के रूप म ेंजनयुक्त करेगी :
परंतु यदद जनयुक्त दकया गया ्यकजक्त अपना पद ग्रहण नहीं करता ह या उसी कल ण्डर िषच के दौरान दकसी भी
समय पद ग्रहण करने के पश्चात ् या तो अपने पद से त्यागपत्र दे देता ह या उससे ह ा ददया जाता ह या उसकअ मृत्यु
हो जाती ह तो लोकपाल बीमा पररषद,् अजधमान के िम के अनुसार उपजनयम (7) म ें जनर्ददि आरजक्षत अ‍यथथ को,
उसकअ रजामंदी अजभजनजश्चत करने के पश्चात,् जनयुक्त कर सकेगी ।”।
6. उक्त जनयम के उपजनयम (8) के स्ट्थान पर, जनम्नजलजखत जनयम रखा जाएगा, अथाचत ्:—
“8. बीमा लोकपाल कअ पदािजध—बीमा लोकपाल, तीन िषच कअ अिजध के जलए या उसके द्वारा अड़सि िषच कअ
आयु प्राप्त करन े तक, इनमें से जो भी पहल े हो, पद धारण करेगा और पुन:जनयुजक्त के जलए पात्र नहीं होगा :[भाग II—खण् ड 3(i)] भारत का राजपत्र : असाधारण 5
परंत ु तारीख 2 माचच, 2021 को उस रूप म ें पद धारण करन े िाला प्रत्येक बीमा लोकपाल, अपनी जनयुजक्त के
समय जिजनर्ददि अिजध के जलए या उसके द्वारा सत्तर िष च कअ आयु प्राप्त करन े तक, इनमें से जो भी पहल े हो, पद
धारण करता रहगे ा ।”।
7. उक्त जनयम के जनयम (9) म,ें “कायचकाल के दौरान गंभीर कदाचार” िब्दस के स्ट्थान पर, “पदािजध के दौरान घोर
अिचार या िारीररक अक्षमता, जचत्त जिकृजत या ददिाजलयापन या दकसी अपराध के जलए दोषजसजका, जजसम ें न जतक
अधमता अतं िचजलत ह, या दकसी अ्‍य संदत्त जनयोजन में िचनबंध या जहत का कराि या चयन प्रदिया के भाग के रूप म ें
ऐसी जानकारी का ददया जाना, जो जमथ्या ह या ताजविक तथ्यस को जिजनर्ददि करने का लोप करती ह, ” िब्द रखे जाएगं े ।
8. उक्त जनयम के जनयम (11) म,ें उपजनयम (3) के पश्चात,् जनम्नजलजखत उपजनयम अतं :स्ट्थाजपत दकया जाएगा,
अथाचत:् —
“(4) उपजनयम (1) और उपजनयम (2) में दकसी बात के होत े हुए भी, जहां बीमा लोकपाल कायाचलय म,ें जो
उपजनयम (1) के अधीन लोकपाल बीमा पररषद ्द्वारा यथा जिजनर्ददि राज्य क्षेत्रीय अजधकाररता रखता ह, कोई ररजक्त
ह, िहा ं लोकपाल बीमा पररषद,् यदद उसका यह समाधान हो जाता ह दक लोकजहत म ें ऐसा करना आिश्यक ह ,
आदेि द्वारा, छह मास से अनजधक कअ अिजध के जलए या ररक्त पद को भरे जान े तक या उसकअ पदािजध के समाप्त
होने तक, इनम ें से जो भी पूिचतम हो, अपनी अजधकाररता के क्षेत्र के अजतररक्त ऐसे पद के कृत्यस का जनिचहन करने के
जलए दकसी अ्‍य लोकपाल को प्राजधकृत कर सकेगी ।”।
9. उक्त जनयम के जनयम (13) के उपजनयम (1) म,ें —
(क) “या संबंजधत जििादस को स्ट्िीकार करेगा या उन पर जिचार करेगा” िब्दस के स्ट्थान पर, “बीमाकता च (जजसके
अंतगतच उसके अजभकताच और मध्यितथ भी ह)ैं या बीमा दलाल के अपेजक्षत कायच जन्‍पादन म ें जनम्नजलजखत आधारस म ें
से दकसी आधार पर कमी का अजभकथन करन े से संबंजधत जिकायतस पर जिचार करेगा,” िब्द रखे जाएंग े;
(ख) खडं (झ) के स्ट्थान पर, जनम्नजलजखत खडं रखा जाएगा, अथाचत् :—
“(झ) प्राजधकरण द्वारा, पाजलसीधारकस के जहतस कअ संरक्षा या अ्‍यथा के संबंध म ें बनाए गए दकसी
जिजनयम या प्राजधकरण द्वारा जारी दकसी पररपत्र, मागचदिथ जसकाांत या जनदेि के या पाजलसी संजिदा के
जनबंधन और ितों के उपबंधस, जहां तक ऐस े जिषयस का संबधं खडं (क) स े खंड (ज) म ें जनर्ददि मुद्दस स े ह,ैं के
अननुपालन से उत्पन्न होने िाला कोई अ्‍य जिषय ;”;
(ग) जनम्नजलजखत स्ट्पिीकरण अतं :स्ट्थाजपत दकया जाएगा, अथातच ् :—
‘स्ट्पिीकरण—इस उपजनयम के प्रयोजन के जलए, “कमी” पद का िही अथ च होगा, जो उसका उपभोक्ता
संरक्षण अजधजनयम, 2019 (2019 का 35) कअ धारा 2 के खंड (11) में ह ।’।
10. उक्त जनयम के जनयम 14 म,ें —
(i) उपजनयम (1) म,ें —
(क) “कोई बीमाकताच” िब्दस के पश्चात,् “या बीमा दलाल” िब्द अंत:स्ट्थाजपत दकए जाएंग े;
(ख) “बीमाकताच” िब्द के स्ट्थान पर, “, यथाजस्ट्थजत, बीमाकता च या बीमा दलाल” िब्द रखे जाएगं े ;
(ii) उपजनयम (2) म,ें “हस्ट्ताक्षररत होगी” िब्दस के स्ट्थान पर, “हस्ट्ताक्षररत होगी या इल ‍राजनक मले के
माध्यम से या लोकपाल बीमा पररषद ्कअ िेबसाइ के माध्यम से आन-लाइन कअ जाएगी” िब्द रख ेजाएंगे ;
(iii) उपजनयम (3) म,ें —
(अ) “बीमाकताच” िब्द के स्ट्थान पर, जहां-जहां िह आता ह, “, यथाजस्ट्थजत, बीमाकता च या बीमा दलाल”
िब्द रखे जाएंग े;6 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
(आ) खंड (क) म,ें “जलजखत अ‍यािेदन नहीं करता ह” िब्दस के स्ट्थान पर, “जलजखत म ें या इल ‍राजनक
मेल के माध्यम से या संबंजधत बीमाकताच या बीमा दलाल कअ िेबसाइ के माध्यम स े आन-लाइन अ‍यािेदन
नहीं दकया ह” िब्द रखे जाएगं े ;
(iv) उपजनयम (4) म,ें “बीमाकता”च िब्द के स्ट्थान पर, “, यथाजस्ट्थजत, बीमाकताच या बीमा दलाल” िब्द रख े
जाएंगे ;
(v) उपजनयम (5) के पश्चात,् जनम्नजलजखत उपजनयम अंत:स्ट्थाजपत दकया जाएगा, अथाचत ् :—
“(6) लोकपाल बीमा पररषद,् जिकायत प्रबंध प्रणाली जिकजसत करेगी, जजसके अंतगचत उपजनयम (14) के
अधीन जिकायतस को आनलाइन प्रस्ट्ततु करन े के जलए और उसकअ रेंदकग के प्रयोजन के जलए जिकजसत
आनलाइन ‍ले फामच भी होगा ।”।
11. उक्त जनयम के जनयम 15 म,ें —
(i) उपजनयम (2) म,ें “बीमाकता”च िब्द के स्ट्थान पर, “, यथाजस्ट्थजत, बीमाकताच या बीमा दलाल” िब्द रख े
जाएंगे ;
(ii) उपजनयम (4) के पश्चात,् जनम्नजलजखत उपजनयम अंत:स्ट्थाजपत दकया जाएगा, अथाचत् :—
“(5) लोकपाल, यदद उसका यह समाधान हो जाता ह दक पररजस्ट्थजतयस म ें ऐसा करना अपेजक्षत ह तो इस
संबंध में लोकपाल बीमा पररषद ् द्वारा जारी और इसकअ िेबसाइ पर प्रकाजित मागचदिथ जसकाांतस के अधीन
रहत े हुए, संबंजधत जिकायतकता च तथा बीमाकताच या बीमा दलाल को अजधसूजचत करन े के पश्चात्, स्ट्िप्रेरणा स े
या जिकायतकता च के अनुरोध पर, िीजडयो कांफ्रेंस के माध्यम स ेमामले कअ सुनिाई कर सकेगा :
परंत ु लोकपाल, यथाजस्ट्थजत, बीमाकता च (जजसके अतं गचत उसके अजभकता च और मध्यितथ भी ह)ैं या बीमा
दलाल को, िीजडयो कांफ्रेंस के माध्यम से, सुने जान े के जलए अनु्ञतात कर सकेगा ।”।
12. उक्त जनयम के जनयम 16 में, “बीमाकताच” िब्द के स्ट्थान पर, जहां-जहां िह आता ह, “, यथाजस्ट्थजत, बीमाकता च या
बीमा दलाल” िब्द रखे जाएंग े ।
13. उक्त जनयम के जनयम 17 म,ें —
(i) उपजनयम (5) म,ें “बीमाकता”च िब्द के स्ट्थान पर, “, यथाजस्ट्थजत, बीमाकताच या बीमा दलाल” िब्द रख े
जाएंगे ;
(ii) उपजनयम (6) म,ें —
(अ) “बीमाकताच” िब्द के स्ट्थान पर, “, यथाजस्ट्थजत, बीमाकता च या बीमा दलाल” िब्द रखे जाएगं े ;
(आ) “को सूजचत करेगा” िब्दस के पश्चात,् “और जिकायत प्रबंध प्रणाली में ब्यौरस को अपलोड करेगा”
िब्द अंत:स्ट्थाजपत दकए जाएंग े;
(iii) उपजनयम (8) म,ें “बीमाकताचओं” िब्द के स्ट्थान पर, “, यथाजस्ट्थजत, बीमाकताचओं या बीमा दलालस” िब्द
रखे जाएंग े ।
[फा.सं. 14019/02/2019-आईएनएस.2]
सौरभ जमश्रा, संयुक्त सजचि
र ‍पण: मूल जनयम, भारत के राजपत्र, असाधारण, भाग II, खंड 3, उपखंड (i), तारीख 27 अप्र ल, 2017 म,ें अजधसूचना
सं‍या सा.का.जन. 413(अ), तारीख 25 अप्रल , 2017 द्वारा प्रकाजित दकए गए थ े और तत्पश्चात ् अजधसूचना
सं‍या सा.का.जन. 785(अ), तारीख 17 अगस्ट्त, 2018 द्वारा उसमें संिोधन दकया गया ।[भाग II—खण् ड 3(i)] भारत का राजपत्र : असाधारण 7
MINISTRY OF FINANCE
(Department of Financial Services)
NOTIFICATION
New Delhi, the 2nd March, 2021
G.S.R. 147(E).—Whereas, certain draft rules, namely, the Insurance Ombudsman (Amendment) Rules,
2020, were published in the Gazette of India, Extraordinary, Part II, Section 3, Sub-section (i), dated 22nd December,
2020 under the notification of the Government of India in the Ministry of Finance (Department of Financial Services)
number G.S.R. 788 (E), dated the 22nd December, 2020, inviting objections or suggestions from persons likely to be
affected thereby before the expiry of a period of forty-five days from the date on which the copies of the Official
Gazette containing the said notification were made available to the public;
And whereas, copies of the said Official Gazette were made available to the public on the 22nd December
2020;
And whereas, the objections and suggestions received from the public on the said draft rules have been
considered by the Central Government.
Now, therefore, in exercise of the powers conferred by section 24 of the Insurance Regulatory and
Development Authority Act, 1999 (41 of 1999), the Central Government hereby makes the following rules further to
amend the Insurance Ombudsman Rules, 2017 (hereinafter referred to as the said rules), namely:—
1. (1) These rules may be called the Insurance Ombudsman (Amendment) Rules, 2021.
(2) They shall come into force from the date of their publication in the Official Gazette.
2. In the Insurance Ombudsman Rules, 2017,—
(i) for the letters ―IRDAI‖ wherever they occur, the word ―Authority‖ shall be substituted;
(ii) for the words ―Executive Council of Insurers‖ wherever they occur, the word ―Council for Insurance
Ombudsmen‖ shall be substituted.
3. In rule 4 of the said rules, in sub-rule (1),—
(i) for clause (d), the following clause shall be substituted, namely:—
‗(d) ―Council for Insurance Ombudsmen‖ means the Council for Insurance Ombudsmen constituted
under rule 5;‘
(ii) in clause (e), for the word ―established‖, the word ―appointed‖ shall be substituted;
(iii) clause (f) shall be omitted;
(iv) after clause (k), the following clause shall be inserted, namely:—
‗(l) ―insurance broker‖ means a person who has been granted a certificate of registration as an
insurance broker by the Authority;‘.
4. In rule 5 of the said rules, in sub-rule (2), in clause (v), for the word ―Director‖, the words ―Joint Secretary or
equivalent‖ shall be substituted.
5. For rule 7 of the said rules, the following rules shall be substituted, namely:—
―7. Selection Committee for appointment of Insurance Ombudsman.—(1) The Council for Insurance
Ombudsmen shall appoint such number of Insurance Ombudsman for such territorial jurisdiction as the
Council for Insurance Ombudsmen may specify, for discharging the duties and functions under these rules.
(2) The Insurance Ombudsman shall be appointed by the Council for Insurance Ombudsmen on the
recommendations of the Selection Committee consisting of the following members, namely:—
(a) the Chairperson of the Authority, or such other whole-time member of the Authority entrusted
with matters relating to the general or life insurance business as the Chairperson may authorise
— chairperson;
(b) one individual drawn from amongst the non-official members of the Banks Board Bureau
possessing necessary expertise and experience in matters relating to general insurance business
— member;
(c) one individual drawn from amongst the non-official members of the Banks Board Bureau
possessing necessary expertise and experience in matters relating to life insurance business —
member;
(d) one individual with a track record of promoting consumer rights or advancing the cause of
consumer protection in the insurance sector — member; and
(e) the representative of the Central Government referred to in clause (v) of sub-rule (2) of rule 5
— member.8 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
Explanation.—In this sub-rule, the expression ―Banks Board Bureau‖ means the autonomous body named as
such, set up by the Central Government for selection of whole-time directors of public sector insurance
companies.
(3) Where there is vacancy in the office of the non-official member referred to in clause (b) or clause (c) of
sub-rule (2), the Central Government may nominate another individual eligible to be such non-official
member in matters referred to in the said clauses to be a member of the Selection Committee.
(4) The Council for Insurance Ombudsmen shall invite applications by advertisement for selection of
Insurance Ombudsman and such advertisement shall be issued in respect of each vacancy existing in the
office of the Insurance Ombudsman at the beginning of a calendar year including any vacancy likely to arise
in that calendar year.
7A. Qualification for appointment of Insurance Ombudsman.—A person shall not be qualified for
appointment as Insurance Ombudsman, unless he—
(i) is not less than fifty-five years but not exceeding sixty-five years of age as on the last date
specified for receipt of application in the advertisement;
(ii) is, or has been, a member of an all-India service or a civil service of the Union and has held a
post of Joint Secretary or equivalent to the Government of India; or
(iii) has served for at least twenty-five years in the insurance industry and has held a post not less
than one level below that of a director of a board.
7B. Procedure and selection criteria for appointment of Insurance Ombudsman.—(1) The Council for
Insurance Ombudsmen shall shortlist up to five candidates from each category of applicants specified in
clauses (ii) and (iii) of rule 7A, for each vacancy from amongst eligible applicants, reckoned on the basis of
the length of service of the applicants in their respective category:
Provided that where the number of candidates to be shortlisted exceeds the number specified under
this rule, on account of two or more candidates having the same length of service, all candidates with such
length shall be included in the shortlist.
Explanation.—For the purposes of this rule, the length of service, in respect of an applicant—
(i) who is serving as or has served as a member of an all-India service or a civil service of the Union,
shall be reckoned from the date of his first appointment as Joint Secretary to the Government of
India or equivalent thereof in the Central Government; and
(ii) who has served in the insurance industry, shall be reckoned from the date of his first appointment
to a position either immediately below the level of a director of a board in the insurance industry or
at the level of a director of a board, whichever is earlier.
(2) Each shortlisted candidate shall furnish the following particulars, in such manner and form as the Council
for Insurance Ombudsmen may specify, namely:—
(a) a declaration and undertaking that he shall ensure absence of conflict of interest in the discharge of
functions and duties of Insurance Ombudsman; and
(b) information in respect of—
(i) personal identification details, including income-tax Permanent Account Number, bank
account numbers and Director Identification Number;
(ii) professional history, including directorships;
(iii) disclosure regarding criminal prosecution, if any;
(iv) the financial interests, including beneficial ownership, of the candidate and his relatives;
(v) organisational affiliations;
(vi) disclosure regarding the candidate or his relatives—
(A) being a promoter or director or employee of,
(B) having material pecuniary relationship with,
(C) being an employee or proprietor or partner in a firm of auditors, company
secretaries or cost accountants of, or in a legal or consulting firm having
material transactions with, and
(D) being chief executive or director of any non-profit organisation that has
material receipts from,
an insurer or its holding, subsidiary or associate company;[भाग II—खण् ड 3(i)] भारत का राजपत्र : असाधारण 9
(vii) disclosure regarding the candidate or his relatives holding shares in excess of two per
cent. in, or being a material supplier, service provider or customer of, or being a lessor or
lessee of, an insurer.
(3) The Council for Insurance Ombudsmen shall convey to the Authority, the particulars under sub-rule (2) for
its opinion as to the applicant‘s suitability, integrity and absence of conflict of interest, keeping in view the
information conveyed and such other information as it may consider relevant.
(4) After considering the opinion of the Authority under sub-rule (3), the particulars of the candidates referred
to in sub-rule (2) shall be laid before the selection committee which shall take into account the suitability of the
candidates including as to absence of conflict of interest and finalise the process of shortlisting of candidates
for interaction.
(5) In respect of candidates figuring in the shortlist finalised by the selection committee under sub-rule (4) who
are public servants or officials falling within the scope of the powers and functions of the Central Vigilance
Commission established under the Central Vigilance Commission Act, 2003 (45 of 2003), the Council for
Insurance Ombudsmen shall obtain the vigilance clearance through the Ministry of Finance, Department of
Financial Services.
(6) In respect of candidates figuring in the shortlist finalised by the selection committee under sub-rule (4) who
are other than those referred to in sub-rule (5), the Council for Insurance Ombudsmen shall furnish the
information referred to in sub-rule (2) to the Directorates of Enforcement, Revenue Intelligence and Goods and
Service Tax Intelligence, and the Central Board of Direct Taxes for their reports on any inquiry or investigation
or proceeding instituted against such candidate.
(7) The selection committee shall, after giving an opportunity for interaction to all the candidates shortlisted by
it under sub-rule (4), recommend to the Council for Insurance Ombudsmen a candidate for appointment against
each vacancy in the office of Insurance Ombudsman, along with up to two additional candidates in order of
preference as reserve candidates.
(8) The Council for Insurance Ombudsmen shall, after considering the recommendations of the selection
committee under sub-rule (7), appoint the recommended candidate as Insurance Ombudsman unless—
(i) the vigilance clearance required under sub-rule (5) has not been received, or
(ii) the Council for Insurance Ombudsmen is of the opinion that the nature of the inputs is such that it
would not be in public interest that he be so appointed,
and in such a case, the Council for Insurance Ombudsmen may consider a reserve candidate, in accordance
with the order of preference, for appointment.
(9) The Council for Insurance Ombudsmen, after considering of the suitability of the candidates, shall appoint
a candidate as an Insurance Ombudsman:
Provided that if the appointed candidate does not assume office or, after assuming office at any time
during the same calendar year, either resigns his office or is removed therefrom, or dies, then the Council for
Insurance Ombudsmen may appoint the reserve candidate referred to in sub-rule (7), in accordance with the
order of preference, after ascertaining his willingness.‖.
6. For rule 8 of the said rules, the following rule shall be substituted, namely:—
―8. Term of office of Insurance Ombudsman.—An Insurance Ombudsman shall hold office for a term of
three years or till he attains the age of sixty-eight years, whichever is earlier, and shall not be eligible for
reappointment:
Provided that every Insurance Ombudsman holding office as such as on the 2nd day of March, 2021,
may continue to hold office for the term specified at the time of his appointment or till he attains the age of
seventy years, whichever is earlier.‖.
7. In rule 9 of the said rules, after the words ―gross misconduct during the term of office,‖, the words ―or physical
incapacity, or unsoundness of mind, or insolvency, or conviction for an offence involving moral turpitude, or
engagement in any other paid employment, or conflict of interest or furnishing as part of the selection process
information that is false or omits to specify material facts,‖ shall be inserted.
8. In rule 11 of the said rules, after sub-rule (3), the following sub-rule shall be inserted, namely:—
―(4) Notwithstanding anything contained in sub-rules (1) and (2), where there is a vacancy in an office of
Insurance Ombudsman having territorial jurisdiction as specified by the Council for Insurance Ombudsmen
under sub-rule (1), the Council for Insurance Ombudsmen may, if it is satisfied that it is necessary in public
interest so to do, by order, authorise any other Ombudsman to discharge the functions of such office in addition
to his area of jurisdiction for a period not exceeding six months or till the vacancy is filled or till the expiry of
his term of office as Ombudsman, whichever is earliest.‖.10 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
9. In rule 13 of the said rules, in sub-rule (1),—
(a) for the words ―or disputes relating to—‖, the words ―alleging deficiency in performance required of an
insurer (including its agents and intermediaries) or an insurance broker, on any of the following
grounds:—‖ shall be substituted;
(b) for clause (i), the following clause shall be substituted, namely:—
―(i) any other matter arising from non-observance of or non-adherence to the provisions of any
regulations made by the Authority with regard to protection of policyholders‘ interests or
otherwise, or of any circular, guideline or instruction issued by the Authority, or of the terms and
conditions of the policy contract, insofar as such matter relates to issues referred to in clauses (a)
to (h).‖;
(c) the following explanation shall be inserted, namely:—
―Explanation.– For the purpose of this sub-rule, the term ―deficiency‖ shall have the meaning as
assigned to it in clause (11) of section 2 of the Consumer Protection Act, 2019 (35 of 2019).‖.
10. In rule 14 of the said rules,—
(i) in sub-rule (1),—
(a) after the words ―an insurer‖, the words ―or insurance broker‖ shall be inserted;
(b) after the words ―the insurer‖, the words ―or the insurance broker, as the case may be,‖ shall be
inserted;
(ii) in sub-rule (2), for the word ―signed‖, the words ―signed or made by way of electronic mail or online
through the website of the Council for Insurance Ombudsmen,‖ shall be substituted;
(iii) in sub-rule (3),—
(A) after the word ―insurer‖, wherever it occurs, the words ―or insurance broker, as the case may
be,‖ shall be inserted;
(B) in clause (a), for the words ―makes a written representation‖, the words ―has made a
representation in writing or through electronic mail or online through website of the insurer or
insurance broker concerned‖ shall be substituted;
(iv) in sub-rule (4), after the word ―insurer‖, the words ―or insurance broker, as the case may be,‖ shall be
inserted;
(v) after sub-rule (5), the following sub-rule shall be inserted, namely:—
―(6) The Council for Insurance Ombudsmen shall develop a complaints management system, which
shall include an online platform developed for the purpose of online submission and tracking of
the status of complaints made under rule 14.‖.
11. In rule 15 of the said rules,—
(i) in sub-rule (2), after the word ―insurer‖, the words ―or insurance broker, as the case may be,‖ shall be
inserted;
(ii) after sub-rule (4), the following sub-rule shall be inserted, namely:—
―(5) The Ombudsman may, on his own or on the request of the complainant, hear a matter
through video-conference if he is satisfied that circumstances so require, after notifying the
complainant and the insurer or insurance broker concerned, subject to guidelines issued by the
Council for Insurance Ombudsmen in this regard and published on its website:
Provided that the Ombudsman may allow the insurer (including its agents and
intermediaries) or insurance broker, as the case may be, to be heard through video-conference.‖.
12. In rule 16 of the said rules, after the word ―insurer‖, wherever it occurs, the words ―or insurance broker, as the
case may be,‖ shall be inserted.
13. In rule 17 of the said rules,—
(i) in sub-rule (5), after the word ―insurer‖, the words ―or insurance broker, as the case may be,‖ shall be
inserted;
(ii) in sub-rule (6),—
(A) after the word ―insurer‖, the words ―or insurance broker, as the case may be,‖ shall be
inserted;[भाग II—खण् ड 3(i)] भारत का राजपत्र : असाधारण 11
(B) after the words ―the Ombudsman‖, the words ―and upload the details in the complaints
management system‖ shall be inserted;
(iii) in sub-rule (8), after the word ―insurers‖, the words ―or insurance brokers, as the case may be,‖ shall
be inserted.
[F. No. 14019/02/2019-Ins.II]
SAURABH MISHRA, Jt. Secy.
Note: The principal rules were published in the Gazette of India, Extraordinary, Part II, Section 3, Sub-section (i),
dated the 27th April, 2017, vide notification number G.S.R. 413 (E), dated the 25th April, 2017 and were
subsequently amended by notification number G.S.R. 785(E), dated the 17th August, 2018.
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064
and Published by the Controller of Publications, Delhi-110054.
            

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