Thejachünuo Pienyü
Policy holder, Nagabazar Kohima
In the intricate pattern of life, unforeseen challenges often test our resilience. My personal odyssey with the Bank and the protective cocoon of insurance has illuminated the profound benefits of financial preparedness, especially in the face of adversity.
]Back in 2019, when I embarked on a financial journey with Bank of Baroda, Upon the bank's advice, I secured a health insurance policy with a robust coverage of Rs 33,00,000 against critical illnesses linked to the loan. Little did I realize the profound impact that decision would have on my life.
Here is a precise testimony of the complaint case and the order of the Hon’ble Insurance Ombudsman, Guwahati for the favorable resolution of the plaintiff. I share this in an attempt to educate and raise awareness among the general public about the existence and benefits of an ombudsman in the insurance landscape. May this be of help to anyone who is struggling and is unaware of such companies that works in favor of the citizens
What is Ombudsman?
Ombudsman is an official, appointed by the Government, who works as a public advocate to investigate the complaints lodge by private citizens against businesses, institutions, government departments, or other public entities in attempts to resolve the conflicts or concerns raised. In other words, Ombudsman helps people solve problems against companies or organizations, especially a public authority.
On 30th August 2022, I was advised to undergo Cervical Biopsy Test and as per the Test Report, I was diagnosed as suffering from “Carcinoma Cervix FIGO Stage IB1”.
Facing the emotional and financial toll of the diagnosis, I was forced to fund my cancer dialysis from my savings. This posted as a huge financial strain in the repayment of loan EMIs.
Recalling my loan protection policy, I subsequently approached the Respondent Insurer with all documents and medical reports. However to my utter surprise they had repudiated my claim due to non submission of documents. This caused a roadblock in my attempts casting a shadow over my already challenging situation.
Filling a Complaint through online mode, I approached the Insurance Ombudsman writing against the decision of the insurer to the Insurance Ombudsman Forum, Guwahati which is in-charged of the North- East Region.
The said complaint was registered by the Office of the Insurance Ombudsman, Guwahati on 18.12.2023 and an online hearing was conducted on 28.12.2023 by the Insurance Ombudsman, Somnath Ghosh where both the complainant and authorised representative of the Respondent Insurer were present and made submission before the Forum. The former took note of the submissions and perused the documents submitted by the contesting parties.
After thorough analysis and comprehensive understanding of the fact, the Insurance Ombudsman finally issued its award on 12.01.2024- in less than 30 days, directing the Respondent Insurer to settle the claim in my favour at the applicable sum insured under the Critical Illness section within thirty days from the date of the Order.
Seeking recourse through the insurance ombudsman, I witnessed a swift and just resolution. This experience highlighted the indispensable role of the ombudsman in safeguarding the interests of the policyholders, ensuring a fair and expeditious resolution to disputes and guiding customers towards informed financial decisions. Their emphasis on insurance literacy proved instrumental, empowering me to navigate the intricacies of coverage and understanding my rights as a policyholder.
The outcome in my favour is not only a testament of dedication and efficiency but also provides hope and necessary financial support. To mention, there is no charge for filing an appeal in the Insurance Ombudsman, it is really doing a commendable job for the citizens.
As I pen down these words, my heart is brimming with gratitude towards the insurance ombudsman and Bank of Baroda. It is my hope that more individuals become cognizant of their rights, seek redress when needed, and ultimately find solace in the protective umbrella of insurance during life's unpredictable storms.
