Steps to Follow while Filing a Complaint against Health Insurer

There are times when you might get unsatisfied with the services provided by your insurer. During this situation, you can approach the IRDAI for a solution. The insurance regulator can be approached in different ways to escalate an issue.

IRDA has laid down a Turnaround Time (TAT) for the various services rendered by insurance providers to the insured. This rule has been stipulated under the IRDA Protection of Policyholders’ Interests (PPHI) Regulations, 2002. A maximum turnaround time has been set for life insurance companies as well as general insurance companies, based on the type of service or grievance redressal provided by the company.

In the event that the insurance provider does not provide a service or resolve a grievance within the stipulated date, the policyholder can approach the IRDA for a solution. The complaint can be escalated and the IRDA will help resolve the dispute with the insurance provider. In case an adjudication and/ or enquiry is required for the same, the policyholder will have to approach the Consumer Court or Consumer Forum.

Complaint Against Health Insurance Company

Process of Lodging a Complaint against a Health Insurance Company:

Before lodging a complaint against the health insurance provider, the policyholder has to approach the Grievance Redressal Office of the branch. The complaint has to be given in writing with associated documentation. A written acknowledgement will be given to you along with the date of submission of the complaint. Generally, the insurance provider has to resolve the grievance within 15 days. In case this does not happen, the issue can be escalated to the IRDA.

In order to lodge a complaint against a health insurance provider with the IRDA, the policyholder has to get in touch with the Grievance Redressal Cell of the Consumer Affairs Department of IRDA via email or customer care helpline. Once the complaint is lodged, you can use the Integrated Grievance Management System offered by the IRDA to monitor your complaint and its progress. The policyholder can also contact the Insurance Regulatory and Development Authority via letter or fax.

The maximum TAT (Turn Around Time) on complaints/ requests/ grievances related to some of the services offered by health insurance companies are as follows:

Service Rendered Maximum Turn Around Time
Processing the proposal, issue of policy or cancellation of 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
Related to Annuity, Surrender value 10 days
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 requirement 30 days
Death Claim repudiation or settlement with investigation requirement 6 months
Acknowledging a grievance 3 days
Resolving a grievance 15 days

First, contact the grievance cell or helpdesk of your health insurance company regarding your issue. If it’s not resolved within the TAT listed, you can escalate the issue to IRDA. Following are the contact details of some of the leading .

Health Insurance Related Pages

Contact Details of Grievance Cell of Health Insurers:

Insurance Provider Email ID
Oriental Insurance Company
Cholamandalam MS General Insurance
Star Health Insurance
Bajaj Allianz Health Insurance
Care Health Insurance
Bharti AXA Health Insurance
Apollo Munich Health Insurance
Cigna TTK Health Insurance
HDFC Ergo Health Insurance
IFFCO Tokio Health Insurance
L & T Health Insurance
Max Bupa Health Insurance
New India Health Insurance
Universal Sompo Health Insurance
ICICI Lombard Health Insurance
National Health Insurance
Oriental Health Insurance
Reliance Health Insurance
Royal Sundaram Health Insurance
SBI Health Insurance
Future Generali Health Insurance
United India Health Insurance
Agriculture Insurance Company of India Ltd.
Raheja QBE Insurance
Export Credit Guarantee Corporation Limited

Contact Details for Grievance Redressal Cell of the Consumer Affairs Department of IRDA:

Toll Free Number 1800 4254 732/ 155255
E-mail ID
Postal Address Consumer Affairs Department Insurance Regulatory and Development Authority, 3-5-817/818, 9th Floor, United India Towers, Hyderguda, Basheerbagh Hyderabad – 500 029
Fax 040-66789768

Channels for Lodging a Complaint:

These are the main channels for lodging a complaint - the Insurance Ombudsman, the Integrated Grievance Management System and the Consumer Court. These are explained below:

Insurance Ombudsman:

You can seek the assistance of the Insurance Ombudsman in order to escalate an issue which has not been resolved by the insurance provider. You can file a complaint with the Insurance Ombudsman under the following conditions:

  • Your claim has been partially or wholly rejected.
  • You have not received your policy after payment of premium.
  • There is delay in claim settlement
  • There is a dispute regarding premium payable/ premium paid.
  • There is a dispute regarding the terms and conditions specified in the Policy Schedule.

Integrated Grievance Management System:

IRDA had introduced the Integrated Grievance Management System as an online platform where the policyholders having a grievance or dispute with an insurance provider can escalate the same. You can register a complaint as well as track its progress using this system. This grievance redressal and monitoring tools helps the IRDA to provide a centralized access to the policyholder and to classify complaints based on predefined norms.

Under this system, complaints are assigned a unique complaint ID and is assigned to concerned departments for resolution. This helps to monitor market conduct issues as well. This also assigns Turnaround Times (TATs) for all complaints registered and sets up alerts for pending tasks. The system ensures efficient complaint resolution with rule based workflows and detailed reports.

Consumer Court:

If the complaint has still not been resolved, you can register the same with the consumer court. The consumer court has a separate department to handle health insurance grievances, especially those arising out of Unfair Trade Practice/ malpractice/ service issues.

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