How To File A Complaint Against Your Insurance Company: A Step-By-Step Guide

The Insurance Ombudsman’s latest annual report for 2023-24 showed that thousands of people end up fighting over delayed or rejected claims every year. It noted how some prominent insurers had drawn the maximum complaints from policyholders, including both private and public insurers in the top five.

With so many people raising grievances, have you ever wondered what would happen if you were in that situation? There is a proper channel available, and knowing the process can save you a lot of back-and-forth.

Step 1: Start with your insurer

The first step is always to raise the matter with your insurance company’s grievance redressal officer. Put your complaint in writing, attach all relevant documents, and keep a copy. Insurers are supposed to acknowledge within three working days and resolve the matter in two weeks. If you don’t hear back in 30 days, or if the response does not satisfy you, you can move to the next stage.

Step 2: Escalate to Irdai

The regulator, Insurance Regulatory and Development Authority of India (Irdai), has its own grievance mechanism. If you believe the insurer has not addressed your complaint rightly, you can file another grievance through the Bima Bharosa online system, call 1800 4254 732 / 155255, or email complaints@irdai.gov.in

Once lodged, the complaint is forwarded to the insurer for action, and you get a reference number to track progress.

Approach the Ombudsman

If the issue still remains unresolved, the Insurance Ombudsman can step in. This route is open to individual policyholders when:

• The claim amount (including expenses) is up to Rs 30 lakh.

• The complaint is against a policy you bought in your personal capacity.

• You have already given the insurer a chance to respond within 30 days.

The Ombudsman process is simple, wherein the officer first tries to mediate between both parties (policyholder and insurer). If both sides agree on a resolution, the insurer is supposed to settle the issue within 15 days. However, if that does not happen, the Ombudsman will pass an award that is binding and has to be implemented by the insurer within 30 days.

Policyholders, on their part, must ensure they submit all the documents such as the copy of policy, rejection letter from the insurer, and ID proof (like Aadhaar, PAN, etc.).

Currently, there are 17 Ombudsman offices across the country, and you have to file in the jurisdiction that covers your residence or the insurer’s office.

If all else fails

Should you still feel shortchanged, you can approach the Consumer Court. Some policyholders even choose to skip the Ombudsman and go directly to court after Irdai’s intervention.

What complaints qualify

Cases the Ombudsman can take up include delays in claim settlement, partial or total repudiation of claims, disputes over premiums, misrepresentation of policy terms, non-issuance of policies after payment, and policy servicing-related grievances.

The entire mechanism is meant to give policyholders a no-cost, less intimidating option than the court. With health insurance complaints rising year after year, understanding these steps could make all the difference if you ever need to challenge your insurer.