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How to make a Health Insurance complaint against your company in India?

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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-

Insurance Samadhan

Top 8 Reasons to file a complaint against your health insurance provider

  1. Negligence of insurance companies.
  2. Payouts are unsatisfactory.
  3. A policy renewal request has been denied without any valid reason.
  4. Mis-selling of Policies.
  5. Policies are refused as there is a high possibility of the claim being sought for.
  6. Claim rejection.
  7. Sudden hikes in premium.
  8. 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 –

Also Read:  Grievance Redressal norms unveiled by IRDAI for insurers

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 –

SERVICESMAXIMUM TURN AROUND TIME
Processing the proposal, issue of policy or cancellation of a policy15 days
Obtaining a copy of the policy proposal30 days
Service requests for errors or refund or NCB (No Claim Bonus) related service requests10 days
Matters related to Surrender10 days
A Complaint of Survival Benefit, Maturity Claim or penal interest not paid15 days
Raising claim requirements after registering a claim15 days
Death Claim settlement without investigation30 days
Death Claim rejection or settlement with an investigation6 Months
A grievance Acknowledgment3 days
Solving a grievance15 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.

Also Read:  Case Study: Mis-selling of an Insurance Policy by a Broker

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

Visit our website: insurancesamadhan.com

Call us on +91 9513631312

WhatsApp:  9910998252

Mail us at corporate@insurancesamadhan.com

Click here to register your case with us

Insurance Samadhan

Raina Rajpal

One Comment

  1. मेरी पत्नी की पोलीसी 2018 से स्टार हेल्थ मे लगातार चल रही थी नियत दिनांक को आपकी कम्पनी में पोलीसी यह कह कर कराई गई थी नो क्लेम वोनस 9.50 लाख पिछला जुड़ेगा वसीम जी जो आपकी कम्पनी में कराई है पत्नी के नाम जगह मेरा नाम है और पिछला नो क्लेम वोनस नहीं जुड़ा है। मेरे नाम के स्थान पर पत्नी का नाम और नो क्लेम वोनस जोड़े अन्यथा मेरा रूपया वापिस करे

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