Dissecting the role of the insurance ombudsman in Tanzania

To protect the rights and interests of insurance customers in the country, we have the Insurance Ombudsman that ensures insurance companies treat customers fairly. PHOTO | COURTESY

The basic purpose of an insurance plan is to provide financial security to you and your family in case of your misfortunes during the policy tenure. When you buy an insurance, you place your faith in the insurance company to stand by you or your family, when you are not around. When you or your nominee claims the policy benefit, you want to be sure that the insurance company follows the right protocols of claim settlement and addresses all your grievances. The claim process should be smooth and hassle-free.

As it were, things could be unpredictable, and when unfortunate situations arise, it’s essential to have a way to seek justice within a legal framework. This holds even in the insurance world, where policyholders may encounter problems such as insurance mis-selling, claim rejection, or claim short-settled. To protect the rights and interests of insurance customers in the country, we have the Insurance Ombudsman that ensures insurance companies treat customers fairly. Therefore, understanding the role of the Ombudsman is vital for policyholders to navigate insurance-related grievances and seek appropriate redressal.

It is for this purpose that the Government created the Insurance Ombudsman office to handle cases for policyholders, enabling them to settle their insurance complaints out of the court system. Ideally one should approach the grievance redressal team to settle their case. If the case remains unresolved, then the insurance Ombudsman will aim to provide a cost-effective, efficient, and impartial way to resolve insurance-related conflicts.

What is an insurance ombudsman?

The Insurance Ombudsman serves as a dedicated authority for resolving insurance-related problems of insurance customers. Many situations may lead to insurance claim rejection, claim denial, or claim short-settled, which can put a customer at risk of losing money. However, the Ombudsman could be the saviour under such circumstances. The Ombudsman office is there to help in resolving aggrieved customers.

Who is an ombudsman in insurance?

The institution of Ombudsman Insurance in Tanzania was established under section 122(1) of the Insurance Act, 2009. The Ombudsman aims to mitigate issues encountered in settlement of claims. The basic purpose of the formation of an Ombudsman in Insurance is to provide an effective, efficient and unbiased settlement of policyholder’s complaints.

Need for insurance ombudsman?

For cases of insurance mis-selling, claim rejection, and others leave customers frustrated, the Ombudsman is for those people. It’s there to ensure that customers are treated as they should and that in case of any problems these are taken care of in a simple and accessible way. This dedicated authority bridges customers and insurance companies, ensuring customers' voices are heard and any issues they face are promptly addressed.

Concerns you can raise with the insurance ombudsman

The policyholder complaint to the Insurance Ombudsman can be about any of the following: (i) delay in claim settlement of your insurance policy beyond the period specified by the Regulator; (ii) any partial or total rejection of the insurance policy claim by the insurance company; (iii) any dispute or disagreement on the premiums paid or payable; (iv) any discrepancy or misrepresentation in the term and conditions of the insurance contract or policy documents; (v) any complaints relating to the servicing of grievances; (vi) issuance of a policy which is different from the one opted by the policyholder; (vii) non-issuance of insurance even after payment of premiums; and (viii) any other matter that causes a violation of the terms and specifications of the Insurance Act, 2009.

When to approach the insurance ombudsman

You can approach the Ombudsman with your insurance complaint, if you have registered the complaint with your insurance company, and the company has either rejected the complaint, not responded within specified days or has not resolved it to your satisfaction.

The complaint you make in such cases should be in writing as per the Insurance Ombudsman complaint format. You can visit the Ombudsman office to make the complaint or send it through the post, or email. However, you will need to submit a hard copy in case you file the complaint via email. But you should note that the same complaint should not be pending before a court or consumer forum.

Let us look at some of the insurance complaints that the insurance ombudsman has recently addressed: Claim delays; claims rejected by the insurance company; disputes over insurance premiums; confusion over insurance policy terms and conditions; and claim short settlement.

In conclusion -- the office of the Ombudsman plays a vital role for policyholders since it works towards safeguarding their interests. The insurance ombudsman serves as a reliable avenue for lodging a complaint, providing a platform to raise your concerns regarding issues. Moreover, the Insurance Ombudsman offers a streamlined and accessible insurance complaint process that is specifically designed to cater to the needs of policyholders. When it comes to the settlement process of claims, it is quite efficient, as any disagreement must be resolved within the stipulated time frame.