58% surges in Insurance Ombudsman cases: 4 reforms to fix the backlog before it breaks

The Insurance Ombudsman exists for a simple reason. When a policyholder’s complaint is not resolved by the insurer, there should be a forum that is quick, free, and accessible. The current framework is working on a solid premise. However, the growing penetration and awareness of the redressal system is creating a backlog.

At the Insurance Ombudsman, the outstanding caseload grew from 7,202 at the end of 2023-24 to 11,406 at the end of 2024-25: a 58% increase. This is when new cases filed with the ombudsman across these years did not see much growth. If the number of new cases were to rise, the backlog could increase more dramatically.

There is a real risk of this if you go by the numbers at Bima Bharosa, the grievance portal of the Insurance Regulatory and Development Authority of India (IRDAI). New filings with Bima Bharosa jumped nearly 20% during the same period. Unresolved complaints of Bima Bharosa serve as a pipeline for the Ombudsman.


Four reforms could meaningfully make the Ombudsman more efficient. Some require regulatory change. Others can be implemented within the current rules.

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Allow brokers to represent

As per the Insurance Ombudsman Rules, 2017, a complainant must represent themselves before the Ombudsman. A nominee, legal heir or assignee may file on behalf of the policyholder. But a broker—who is legally defined under the Insurance Act as the representative of the policyholder, not the insurer—can’t formally represent a client.

This is an anomaly. The broker is the professional who arranged the policy, negotiated the terms and, in many cases, managed the claim. They know the policy wording, the insurer’s internal processes, and the arguments most likely to succeed on appeal.

A policyholder attending an Ombudsman hearing alone—particularly one who is elderly, in the middle of a medical crisis, or unfamiliar with insurance jargon—is at a structural disadvantage. Their ability to represent is low and they are likely to take many iterations, leading to delays. Allowing brokers to formally represent policyholders wouldn’t dilute the Ombudsman’s authority. It would improve the quality of submissions, reduce procedural errors, and make the forum accessible to those who need it most.

Publish ombudsman decisions

The Ombudsman issues reasoned awards that are binding on insurers and address real disputes such as non-disclosure allegations, clause interpretations, as well as claim rejections on grounds of lifestyle or preexisting conditions. They contain exactly the kind of reasoning that a policyholder preparing their own case would benefit from reading. But the records are not easily accessible.

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The last publicly available set of Ombudsman awards on the IRDAI website appears to date from 2022. More recent decisions are not systematically published in searchable form for general public access. A policyholder whose claim has been rejected for a specific reason has few ways to check whether the Ombudsman ruled on similar facts earlier. This matters for two reasons.

First, accessible precedents would help policyholders build stronger cases. Second, they would act as a deterrent. An insurer that knows its rejection logic has been consistently overturned by the Ombudsman is more likely to reconsider before the escalation happens. Courts publish judgments as a matter of course. The Ombudsman, which functions as a quasi-judicial body, should do the same. A searchable database would meaningfully fix the information asymmetry between policyholders and insurers.

Report what is going wrong

The annual reports of both the Insurance Ombudsman and IRDAI contain data, but it can have more granularity to be effective.

IRDAI’s annual report categorises Bima Bharosa cases by type, such as claimrelated, cover note-related, and so on. The Ombudsman’s report also lists cases admissible under various rules.

However, this classification does not illustrate the recurring case type. For instance, out of the total 3,178 entertainable cases for general insurance in 2024-25, 2,855 cases fell under Rule 13(1)b i.e., any partial or total repudiation of claims by an insurer. If the Ombudsman’s annual report identified, say, that 5% of these cases in a given year involved a specific clause or a specific type of rejection, IRDAI would have a clear basis to issue a clarification or guideline to insurers. Recurring disputes on the same grounds are a signal that the industry needs better guidelines. Better data would allow the regulator to act upstream rather than adjudicate downstream.

Publish resolution and timelines

The Ombudsman annual report publishes the number of complaints by final decision type and resolution timeline. In fact, the IRDAI report includes ageing data on cases pending on the Department of Administrative Reforms and Public Grievances (DARPG) portal.

However, similar reporting of Bima Bharosa’s pending cases, break-up of final disposition type or the resolution turnaround time (TAT) is limited. Publishing this data by insurer would create accountability and push for a better resolution. A more efficient Bima Bharosa would prevent cases moving to the Ombudsman.

The Insurance Ombudsman is a valuable institution and serves as a guardian of trust for the industry. It has resolved hundreds of thousands of disputes for policyholders.

Recently, the compensation cap was raised to Rs.50 lakh from the earlier Rs.30 lakh. This has made the Ombudsman relevant to a wider set of disputes. But a growing backlog, inaccessible precedents, inconsistent reporting, and a rule that prevents the policyholder’s own professional representative from helping them are structural gaps that reforms can address. The framework exists. It needs to be made more useful to the people it was built for.

The Author is Co-Founder, Securenow Insurance Brokers