Filing Complaints Against Health Insurance Companies

Do you feel your health insurance company shows negligence in processing a proposal?

Is there a lapse in processing your claims?

Are you unhappy with your insurer?

If so, you should file a complaint against the health insurance company.

There are times when you run into trouble with your health insurance due to the negligence of the insurance provider. You won’t be happy with the payout received from the insurance company. The insurer may refuse to renew your policy without citing any valid reason.

Such situations can be very frustrating.

To help customers/policy buyers resolve such issues, the Insurance Regulatory and Development Authority of India (IRDAI) allows them to complain to the insurance company. This government body can help you with all aspects and resolve the issue as soon as possible.

Points to Consider While Filling Complaints Against Health Insurance Company

Keep the following points in mind while raising a complaint with IRDAI against your insurer. The IRDAI allows many ways to complain.

1. Write to Your Insurance Company

• First of all, write a complaint with the insurer.
• Send a written letter with the supporting documents to the Grievance Redressal Officer (GRO) of its branch.
• Or you complain with any other office that you deal with.
• And don’t fail to receive a written acknowledgement of the complaint you have filed from the GRO.

Contact details of the officer are available on the policy document issued to you at the time of purchasing health insurance. Or, you can get the details of all the insurance companies at the IRDAI website.

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2. Approach Consumer Affairs Department of IRDAI

All insurance companies must address the complaint within 15 days of receiving the complaint. If the company ignores and doesn’t respond or you are dissatisfied with the action taken by the insurer, you have an option to file a complaint with the Consumer Affairs Department of IRDAI:

• Contact the Grievance Redressal Cell of the Consumer Affairs Department of IRDAI by dialing the toll-free number 155255 or 1800 4254 732.
• Or send an email to complaints@irda.gov.in.
• Or you have the option to fill the Complaint Registration Form with other letters if any vial post or courier.
• The form and address are available on the official website of IRDAI.

3. Integrated Grievance Management System

IRDAI has launched an Integrated Grievance Management System (IGMS). If you’re unable to file the complaint with the Grievance Redress Channel of the Insurance Company, you can register your complaints with IGMS. This system will provide you with a gateway to register complaints with the insurance company and monitor them. To file the complaint and monitor it, register by filling out details at igms.irda.gov.in. Once you file your complaint, a token reference number will be allotted to you.

Here in this system, a unique complaint ID is assigned to all the complaints and thereafter it is assigned to respective departments to resolve. It also helps in monitoring the issues of marketing conduct. A turnaround time(TAT) is also assigned for all the registered complaints and additionally, alerts are also set up for all the further aligned tasks. Through this system, a well organized complaint resolution is ensured along with rule-based detailed reports and workflows.

4. Insurance Ombudsman

If you are still dissatisfied, you have the right to approach the insurance or file a civil complaint against the insurance company before a civil court. It is a quick judicial body, which deals with cases up to a value of Rs. 20 lakh. The insurance Ombudsman reserves the power to award compensation to the aggrieved party. Under the following conditions, you can register a complaint with the Insurance Ombudsman:

• In case there is any delay in claim settlement.
• In case there is any dispute associated with the premium paid or premium payable.
• In case, there is a rejection of your claim either partially or completely.
• In case you haven’t received your insurance plan even after paying the premium.
• In case any dispute arises due to differences in terms and conditions mentioned in the policy document.

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Conclusion

You have several ways to file a complaint against your insurer in case you are not satisfied with it. It’s important to note before approaching IRDAI, first lodge a complaint with your insurance company. The IGMS system also allows you to first amend your complaint in midway.

For more information about lodging complaints against an insurer or to know any other information about health insurance, get in touch with our experts at 1800-120-5698.