An Economic Times article reported on the delays being caused at insurance ombudsman offices. India’s insurance ombudsman mechanism, intended as an accessible dispute resolution platform for policyholders, is facing mounting criticism for prolonged delays that are undermining its effectiveness. While official figures suggest a majority of complaints are addressed within statutory timeframes, real-world experiences and sector commentary point to persistent backlogs, leaving many consumers waiting months, or in some cases more than a year, for hearings or resolutions.
Real Cases Highlight Human Impact
Economic Times reported the case of Seema Pandey, a 43-year-old resident of Thane, whose claim for ovarian cancer treatment was repudiated by her insurer in April 2025 on grounds of non-disclosure of a pre-existing condition. After escalating to the insurance ombudsman in June 2025, her matter remains unheard, despite mounting treatment costs and repeated follow-ups by her family.
Similarly, Pratiksha Jadhav from Ahilyanagar (formerly Ahmednagar) saw her claim for dengue treatment rejected in 2024. Despite submitting all required documents to the Pune ombudsman in April 2025, she too has yet to be given a hearing date.
These individual stories reflect broader systemic issues, where unresolved complaints extend well beyond the timelines envisioned under the current regulatory framework.
Also Read: What You Should Do In Case Of Health Insurance Claim Rejection
The Official Picture: Mixed Signals
According to the Council for Insurance Ombudsmen (CIO) annual report for 2024–25,
- out of 60,304 complaints handled by the 18 ombudsman centres nationwide,
- 48,898 (81%) were disposed of during the year.
- Of these, 53% were resolved within one month and
- 29% within one to three months.
However,
- 6,452 took three months to one year, and
- 2,594 stretched beyond a year.
- At the year’s end, 11,406 complaints remained outstanding,
- with 830 pending for over 12 months.
Official targets require an ombudsman to issue an award within three months of receiving all documentation, yet insurers and consumer advocates say many hearings are scheduled far later, sometimes six months or more after initial submission.
Backlog Concentrated in Major Centres
The backlog is most acute in high-traffic centres. As of March 2025, Pune accounted for 826 of the 830 cases pending over a year, while Mumbai had four such cases. Both centres lacked full-time ombudsmen for extended periods, contributing to delays.
In late 2025, the Mumbai ombudsman reported that when a full-time official took charge in December 2024, 3,155 cases were outstanding—with 300 of these older than a year. In 2025 alone, the office resolved 2,650 of the 4,990 backlog cases, underscoring the impact that staffing can have on throughput.
Recent media coverage also noted that ombudsman positions, such as in Mumbai, have remained vacant for extended periods, with officials juggling multiple offices. Recruitment processes for ombudsmen can take more than a year, further exacerbating backlog pressures.
Wider Industry Context: Rising Complaints
Data from broader insurance grievance trends highlight growing stress on redressal mechanisms. In the fiscal year 2024–25, health and general insurance grievances surged, with approximately 69% of complaints related to claims, and mis-selling issues particularly affecting life insurance customers. This increase suggests that pressure on the ombudsman system may continue to intensify unless structural reforms are implemented.
Independent consumer discussions and industry commentary also point to widespread frustrations among complainants. Some policyholders reported on Reddit about waiting six months or more for ombudsman hearings, with inconsistent communication and unclear timelines.
Proposed Reforms and Solutions
Industry experts and regulators recognize the need for reform. Former IRDAI member Nilesh Sathe notes that rising caseloads reflect increased consumer awareness rather than a deterioration in insurer behaviour, but that the number of ombudsman offices must expand to meet demand.
The Insurance Regulatory and Development Authority of India (IRDAI) has proposed the introduction of internal ombudsmen within insurers. These board-appointed officers would resolve complaints up to Rs.50 lakh within 15 days, with binding decisions, potentially reducing escalation to external ombudsmen.
Additional proposed changes include redistributing cases from overloaded urban centres to less-busy offices and granting the Council for Insurance Ombudsmen authority to allocate online complaints based on workload.
Conclusion
While official statistics show that a significant proportion of insurance disputes are resolved within statutory timeframes, on-the-ground realities paint a different picture for many policyholders, especially in high-volume centres. Persistent delays erode trust in the ombudsman system and highlight the need for regulatory reform, greater staffing, and process improvements to ensure timely and effective consumer protection.