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How to File a Complaint against a Health Insurance Company?

Published On Apr 18, 2021, Updated On May 13, 2021

If you feel unhappy with the services offered by your health insurance company, then in such a scenario you can go to the Insurance Regulatory and Development Authority of India( IRDAI) in order to seek a solution for your problem. There are different ways through which you can approach them.

There are many reasons as to why a policyholder would want to file a complaint against their respective health insurance company. In case you are able to relate to any of the below mentioned issues, then proceed ahead by filing a complaint against health insurance provider or legally with consumer court or IRDA:

  • Rejection of Claim
  • Unsatisfactory Payouts
  • Negligence on insurance providers part
  • Denial of Policy Renewal Request
  • Premium Hike
  • Additional Policy Features costing more
  • Mis-selling of Insurance Plans

How to File a Complaint against a Health Insurance Company?

How to Lodge a Complaint against your Health Insurance Company?

The following are the ways through which you can register a complaint against your health insurance provider:

  • Register a Complaint with your Health Insurance Company

The policyholder should send their grievance in written alongside all the necessary documents to the respective insurance provider grievance redressal officer, and thereafter they should get an acknowledgement in written. The details of contact are mentioned on the policy document and official website of the insurance company or IRDAI.

Within 15 days of receiving the receipt, the insurance company needs to address the complaint. In case, they fail to do so or you are unsatisfied with the received response, you can then proceed to file a complaint with IRDA.

  • Integrated Grievance Management System (IGMS)

Integrated Grievance Management System is an online complaint filing platform launched by IRDA, wherein the policyholders having any kind of complaint or dispute with their health insurance company can register with them in order to further escalate the process. With the help of these grievance redressal and monitoring tools, IRDA can offer a centralized access to the insured individual and to categorize the complaints depending upon pre-defined norms.

Under the IGMS, a distinctive complaint ID is allocated to all the registered complaints and afterwards, it is given to all the concerned departments for resolution of the grievance. Moreover, a turnaround time( TAT) is also assigned for all the lodged complaints and notifications are set up for all the unresolved tasks.

  • Insurance Ombudsman

In case you are not satisfied, then you can go to the Insurance Ombudsman. The policyholder can seek help from the Insurance Ombudsman to raise an issue which is yet not resolved by your respective insurance company. Under the below mentioned situations, you are eligible to raise a complaint with the Insurance Ombudsman:

  1. If the claim of the policyholder gets partially or completely rejected.
  2. If there is a controversy between insurance provider and policyholder for disagreement related to premium paid or payable.
  3. If the policyholder faces any set back in claim settlement.
  4. If there is any kind of disagreement between insurance provider and policyholder because of terms and conditions mentioned in the policy document.
  5. If the policyholder has not received their insurance plan even after payment of premium.
  • Consumer Court

    In case, your grievance has still not been settled, then you can opt to file the complaint with the consumer court. There is a distinct department in the consumer court to look after the health insurance grievances, especially the ones that arise because of service issues, unfair trade practices, etc.

Final Words

There are several channels to assist the policyholder in filing a complaint against their insurance company if they are not happy with the services. However, it is significant to note that before proceeding to IRDA, a policyholder should first file a complaint with their insurance company.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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