{"id":375,"date":"2020-09-28T13:12:26","date_gmt":"2020-09-28T13:12:26","guid":{"rendered":"http:\/\/blog.insurancesamadhan.com\/?p=375"},"modified":"2022-08-31T13:12:23","modified_gmt":"2022-08-31T07:42:23","slug":"how-to-file-a-complaint-against-health-insurance-company","status":"publish","type":"post","link":"http:\/\/www.insurancesamadhan.com\/blog\/how-to-file-a-complaint-against-health-insurance-company\/","title":{"rendered":"How to make a Health Insurance complaint against your company in India?"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_76 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-file-a-complaint-against-health-insurance-company\/#Top_8_Reasons_to_file_a_complaint_against_your_health_insurance_provider\" >Top 8 Reasons to file a complaint against your health insurance provider<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-file-a-complaint-against-health-insurance-company\/#Steps_to_file_a_complaint_against_your_health_insurance_company_in_India\" >Steps to file a complaint against your health insurance company in India<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-file-a-complaint-against-health-insurance-company\/#Step_1_File_a_formal_complaint_with_your_insurer\" >Step 1: File a formal complaint with your insurer<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-file-a-complaint-against-health-insurance-company\/#Step_2_Register_a_complaint_with_IGMS_Integrated_grievance_management_system_of_IRDA\" >Step 2: Register a complaint with IGMS (Integrated grievance management system) of IRDA.<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-file-a-complaint-against-health-insurance-company\/#Step_3_Talk_to_an_Ombudsman\" >Step 3: Talk to an Ombudsman<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-file-a-complaint-against-health-insurance-company\/#Step_4_Sue_your_health_insurance_provider_in_civil_court\" >Step 4: Sue your health insurance provider in civil court.<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\r\n<p>If you are a health insurance policy owner and a regular premium payer, you have every right to expect that all your medical claims would be taken care of (obviously, only the ones covered in your health insurance policy) and that your insurer efficiently executes their services with an impartial mindset, especially in times of medical distresses which have a big toll on your mental and financial state.<\/p>\r\n\r\n\r\n\r\n<p>There are some more reasons as to why a grievance may arise with your health insurance provider that might compel you to file a complaint. if you relate to any of the listed issues given below, you&#8217;d want to\u00a0<a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=google&amp;utm_medium=organic&amp;utm_campaign=blog\">file a insurance complaint<\/a>\u00a0against your insurance company or legally with the IRDA or consumer court-<\/p>\r\n\r\n\r\n<center><a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=organic&amp;utm_medium=blog&amp;utm_campaign=blog_post&amp;utm_term=blog_term\"><img decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/stage.insurancesamadhan.com\/assets\/img\/contact.png\" alt=\"Insurance Samadhan\" width=\"500\" height=\"70\" border=\"0\" \/><\/a><\/center>\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Top_8_Reasons_to_file_a_complaint_against_your_health_insurance_provider\"><\/span>Top 8 Reasons to file a complaint against your health insurance provider<span class=\"ez-toc-section-end\"><\/span><\/h2>\r\n\r\n\r\n\r\n<ol class=\"wp-block-list\">\r\n<li>Negligence of insurance companies.<\/li>\r\n<li>Payouts are unsatisfactory.<\/li>\r\n<li>A policy renewal request has been denied without any valid reason.<\/li>\r\n<li>Mis-selling of Policies.<\/li>\r\n<li>Policies are refused as there is a high possibility of the claim being sought for.<\/li>\r\n<li>Claim rejection.<\/li>\r\n<li>Sudden hikes in premium.<\/li>\r\n<li>Added features in your policy cost you more money.<\/li>\r\n<\/ol>\r\n\r\n\r\n\r\n<p>If you have faced any of these issues, here\u2019s how you can file for a complaint &#8211;<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Steps_to_file_a_complaint_against_your_health_insurance_company_in_India\"><\/span>Steps to file a complaint against your health insurance company in India<span class=\"ez-toc-section-end\"><\/span><\/h2>\r\n\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Step_1_File_a_formal_complaint_with_your_insurer\"><\/span>Step 1: File a formal complaint with your insurer<span class=\"ez-toc-section-end\"><\/span><\/h3>\r\n\r\n\r\n\r\n<p>Before lodging, a complaint against your health insurance provider legally, approach the\u00a0<a href=\"https:\/\/www.insurancesamadhan.com\/blog\/grievance-redressal-norms-unveiled-by-irdai-for-insurers\/\">Grievance Redressal<\/a>\u00a0Officer of the branch, details of which are given in your policy document or on their website.<\/p>\r\n\r\n\r\n\r\n<p>The complaint has to be given in writing with relevant documentation. A written acknowledgment will be given to you along with the date of submission of the complaint.<\/p>\r\n\r\n\r\n\r\n<p>Health insurance companies have a maximum Turn Around Time (TAT) on complaints\/grievances\/requests related to some of the services offered by them, here is a list of their TAT\u2019s &#8211;<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-table\">\r\n<table>\r\n<tbody>\r\n<tr>\r\n<th>SERVICES<\/th>\r\n<th>MAXIMUM TURN AROUND TIME<\/th>\r\n<\/tr>\r\n<tr>\r\n<td>Processing the proposal, issue of policy or cancellation of a policy<\/td>\r\n<td>15 days<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Obtaining a copy of the policy proposal<\/td>\r\n<td>30 days<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Service requests for errors or refund or NCB (No Claim Bonus) related service requests<\/td>\r\n<td>10 days<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Matters related to Surrender<\/td>\r\n<td>10 days<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>A Complaint of Survival Benefit, Maturity Claim or penal interest not paid<\/td>\r\n<td>15 days<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Raising claim requirements after registering a claim<\/td>\r\n<td>15 days<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Death Claim settlement without investigation<\/td>\r\n<td>30 days<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Death Claim rejection or settlement with an investigation<\/td>\r\n<td>6 Months<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>A grievance Acknowledgment<\/td>\r\n<td>3 days<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Solving a grievance<\/td>\r\n<td>15 days<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>If your grievance is not resolved in 15 days, don\u2019t worry, just follow the next step.<\/p>\r\n\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Step_2_Register_a_complaint_with_IGMS_Integrated_grievance_management_system_of_IRDA\"><\/span>Step 2: Register a complaint with IGMS (Integrated grievance management system) of IRDA.<span class=\"ez-toc-section-end\"><\/span><\/h3>\r\n\r\n\r\n\r\n<p>To take your complaint further, submit a complaint with IGMS, which is the grievance redressal of\u00a0<a href=\"https:\/\/www.insurancesamadhan.com\/blog\/protection-of-policy-holder-interest-by-irda\/\">IRDA<\/a>. You can also track your complaints on their website with your reference number.<\/p>\r\n\r\n\r\n\r\n<p>PS &#8211; Make sure that you have registered a complaint with your insurance company first before approaching IRDA.<\/p>\r\n\r\n\r\n\r\n<p>File a complaint with the IGMS<\/p>\r\n\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Step_3_Talk_to_an_Ombudsman\"><\/span>Step 3: Talk to an Ombudsman<span class=\"ez-toc-section-end\"><\/span><\/h3>\r\n\r\n\r\n\r\n<p>An\u00a0<a href=\"https:\/\/www.insurancesamadhan.com\/blog\/insurance-ombudsman-in-india\/\">Ombudsman<\/a>\u00a0is an official appointed by the government who investigates the grievances of policyholders and arbitrates the dispute. You can approach an ombudsman within a year from the date of receipt of the decision of the insurer which is not to the satisfaction of your complainant.<\/p>\r\n\r\n\r\n\r\n<p>Make sure you take all your documents with you (even the ones that you have been documenting throughout the complaint with your insurer). The chances of you winning the fight with the fraudsters would be higher if you are completely transparent with the ombudsman.<\/p>\r\n\r\n\r\n\r\n<p>Here is the official guide by IRDA to know more about Ombudsman &#8211;\u00a0<a href=\"http:\/\/ecoi.co.in\/faqs.html\">http:\/\/ecoi.co.in\/faqs.html<\/a><\/p>\r\n\r\n\r\n\r\n<p>If this method also does not satisfy you, don\u2019t worry, there is another way.<\/p>\r\n\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Step_4_Sue_your_health_insurance_provider_in_civil_court\"><\/span>Step 4: Sue your health insurance provider in civil court.<span class=\"ez-toc-section-end\"><\/span><\/h3>\r\n\r\n\r\n\r\n<p>Make sure you are prepared for this one, collect all the information you need, and get ready to fight this in court.<\/p>\r\n\r\n\r\n\r\n<p>We at Insurance Samadhan, are here to help you throughout your battle against your health insurer, Register here\u00a0and will be right there with you!<\/p>\r\n\r\n\r\n\r\n<p>You can also<\/p>\r\n<p>Visit our website:\u00a0<a href=\"https:\/\/www.insurancesamadhan.com\/\">insurancesamadhan.com<\/a><\/p>\r\n<p>Call us on +91 9513631312<\/p>\r\n<p>WhatsApp:\u00a0<a href=\"https:\/\/api.whatsapp.com\/send?phone=+919910998252&amp;text=Hi\">\u00a09910998252<\/a><\/p>\r\n<p>Mail us at\u00a0<a href=\"mailto:corporate@insurancesamadhan.com\">corporate@insurancesamadhan.com<\/a><\/p>\r\n<p><a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=organic&amp;utm_medium=blog&amp;utm_campaign=blog_post&amp;utm_term=blog_term\">Click here<\/a>\u00a0to register your case with us<\/p>\r\n<p><a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=organic&amp;utm_medium=blog&amp;utm_campaign=blog_post&amp;utm_term=blog_term\"><img decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/stage.insurancesamadhan.com\/assets\/img\/contact.png\" alt=\"Insurance Samadhan\" width=\"500\" height=\"70\" border=\"0\" \/><\/a><\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>If you are a health insurance policy owner and a regular premium payer, you have every right to expect that all your medical claims would be taken care of (obviously, only the ones covered in your health insurance policy) and&hellip; <a href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-file-a-complaint-against-health-insurance-company\/\" class=\"more-link\">Continue Reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":376,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-375","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>How to file a complaint against your health insurance company in India?<\/title>\n<meta name=\"description\" content=\"Know about the complete process to file a complaint against your health insurance company in India. 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