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.
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’d want to file a insurance complaint against your insurance company or legally with the IRDA or consumer court-
Top 8 Reasons to file a complaint against your health insurance provider
- Negligence of insurance companies.
- Payouts are unsatisfactory.
- A policy renewal request has been denied without any valid reason.
- Mis-selling of Policies.
- Policies are refused as there is a high possibility of the claim being sought for.
- Claim rejection.
- Sudden hikes in premium.
- Added features in your policy cost you more money.
If you have faced any of these issues, here’s how you can file for a complaint –
Steps to file a complaint against your health insurance company in India
Step 1: File a formal complaint with your insurer
Before lodging, a complaint against your health insurance provider legally, approach the Grievance Redressal Officer of the branch, details of which are given in your policy document or on their website.
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.
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’s –
| SERVICES | MAXIMUM TURN AROUND TIME |
|---|---|
| Processing the proposal, issue of policy or cancellation of a policy | 15 days |
| Obtaining a copy of the policy proposal | 30 days |
| Service requests for errors or refund or NCB (No Claim Bonus) related service requests | 10 days |
| Matters related to Surrender | 10 days |
| A Complaint of Survival Benefit, Maturity Claim or penal interest not paid | 15 days |
| Raising claim requirements after registering a claim | 15 days |
| Death Claim settlement without investigation | 30 days |
| Death Claim rejection or settlement with an investigation | 6 Months |
| A grievance Acknowledgment | 3 days |
| Solving a grievance | 15 days |
If your grievance is not resolved in 15 days, don’t worry, just follow the next step.
Step 2: Register a complaint with IGMS (Integrated grievance management system) of IRDA.
To take your complaint further, submit a complaint with IGMS, which is the grievance redressal of IRDA. You can also track your complaints on their website with your reference number.
PS – Make sure that you have registered a complaint with your insurance company first before approaching IRDA.
File a complaint with the IGMS
Step 3: Talk to an Ombudsman
An Ombudsman is 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.
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.
Here is the official guide by IRDA to know more about Ombudsman – http://ecoi.co.in/faqs.html
If this method also does not satisfy you, don’t worry, there is another way.
Step 4: Sue your health insurance provider in civil court.
Make sure you are prepared for this one, collect all the information you need, and get ready to fight this in court.
We at Insurance Samadhan, are here to help you throughout your battle against your health insurer, Register here and will be right there with you!
You can also
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I have taken health insurance from Niva Bhupa on 29 dec 2021 upto 28 dec 2024 and i have a hip joint pain so before admit i launched a claim whose claim id is 1307327,Member id is 11996814 and policy number is 32137842202100,under this policy i already take claim in May 2022 with cash less facility and after that i went for ayurvedic treatment with prior information given to insurance company but at the time of reumbursement insurance company denied for reiumbersement & said this hospital is blacklisted so i argue because i already informed to the company in tollfree number so then they appoint investigator and lucklily by default i mentioned that i was suffering this problem from Nov 2021 so insurance company point out this statement and reject my claim but actually i have this problem from second week of jan 2022 but as per first doctor mentioned pain history i wrongly mentioned pain from Nov 2021,but if you check my documents then every doctor mentioned pain history by different ways so it clearly shows that statement given by me was by default due to first diagnosis and i am insured from 2017 by diffrent differnt companys so its clearly shown that if i have a problem in nov 2021 then i took claim from my previous company but actually i dont required claim at that time.
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