5 min read
Updated on Nov 13, 2022
When we buy a health insurance policy from a health insurance company, we expect some services and benefits from the insurer as mentioned in the policy papers. However, if we do not receive the facilities as promised, we become unsatisfied with the policy provider. If you feel that you are not satisfied with your insurance company, you can approach the IRDAI or Insurance Regulatory and Development Authority of India to find a solution. You can escalate the issue in various ways by means of an IRDA complaint.
There is a certain Turn Around Time (TAT) that the IRDAI has allowed for different services provided by insurance providers. As per rule, the turnaround for life insurance and general insurance is maximum depending on the kind of issue or grievance that is required to be addressed. If the insurer does not comply with the TAT to resolve a particular issue, the policyholder can seek interference by the IRDAI to resolve the same. However, if the policyholder escalates the dispute to IRDAI, the association is required to resolve it with the insurer. Further, if any enquiry is needed regarding the issue, the insured can move towards the consumer court.
Below is the process to lodge a Complaint against a Health Insurance Company:
Below are the steps:
If you want to lodge a complaint with the IRDAI against your insurer, you must contact the IRDAI’s Grievance Redressal Cell. This cell is a part of the Consumer Affairs Department of the association and one can submit the complaint via IRDA Complaint mail id or calling the customer services. IRDAI offers an Integrated System of Grievance Management that monitors the complaint after it is lodged. The insured can get in touch with the association via mail or fax.
Below is the maximum TAT for particular grievances associated to certain services of the health insurers:
|Particular Services||Maximum TAT|
|Proposal Processing & issue or cancellation of a plan||15 days|
|getting the proposal copy of the policy||30 days|
|Grievances related to errors/refund/NCB etc.||10 days|
|Grievances pertaining to Surrender value and Annuity||10 days|
|Requests related to maturity claim, survival benefit or non-payment of penal interest||15 days|
|Concerning claim raising requirements once a claim is registered||15 days|
|For settling death claim without the requirement of investigation||30 days|
|For death claim denial or settlement that needed investigation||6 months|
|Admitting a grievance||3 days|
|Grievance resolution||15 days|
Hence, to initiate the process you need to contact the helpdesk of your insurer to resolve your issue. In case the TAT is over and the issue still persists, you may escalate the problem to IRDAI.
Here are the contact details of the top health insurance companies’ Grievance Cell:
|Insurance Company||Email Address|
|Care Health Insurancefirstname.lastname@example.org|
|Bharti AXA Health Insuranceemail@example.com|
|Bajaj Allianz Health Insurancefirstname.lastname@example.org|
|Apollo Munich Health Insuranceemail@example.com|
|Cholamandalam MS General Insurancefirstname.lastname@example.org|
|IFFCO Tokio Health Insuranceemail@example.com|
|HDFC Ergo Health Insurancefirstname.lastname@example.org|
|Max Bupa Health Insuranceemail@example.com|
|ICICI Lombard Health Insurancefirstname.lastname@example.org|
|Future Generali Health Insuranceemail@example.com|
Contact Details for Grievance Redressal Cell of the Consumer Affairs Department for IRDA complaint:
|Toll Free No.||1800 4254 732/ 155255|
|IRDA Complaint E-mail IDfirstname.lastname@example.org|
|Postal Address||Consumer Affairs Department Insurance Regulatory and Development Authority, 3-5-817/818, 9th Floor, United India Towers, Hyderguda, Basheerbagh Hyderabad – 500 029|
You can lodge a complaint against your insurance provider via three main channels – the Insurance Ombudsman, the Integrated Grievance Management System and the Consumer Court.
Insurance Ombudsman is the first channel in case you want to escalate an issue pending with your insurance provider.
Following are the conditions to file a complaint with the Insurance Ombudsman channel:
Also Read: What is Insurance Ombudsman?
This is an online channel introduced by IRDAI. Here, the policyholder who wants to lodge a complaint against the insurer may escalate the issue. This system allows the complainant to register and track the progress of the complaint online.
Further, this system offers a unique ID to the complaints and dispenses them to the particular departments to get resolved. This way monitoring the complaint becomes easy and also ensures efficient resolution of the issue in a proper system.
Lastly, if the issue persists and is unresolved, the complainant can move to consumer court, which handles grievances related to health insurance separately. You can submit your complaint at the consumer forum complaint email id.
To Sum Up
It is very important to be cautious at the time of buying a health insurance policy. You must read the policy document very carefully and also seek to understand any confusion related to any particular term of the plan. Further, if any issue appears and disturbs you, it can be resolved by following the process as mentioned above.
Moreover, since you already know how to raise a complaint in consumer court, you can easily follow the process to resolve your grievances.
Found this post informational? Browse PayBima Blogs to read interesting posts related to Health Insurance, Car Insurance, Bike Insurance, Term Life Insurance and Investment section. You can visit PayBima to Buy Insurance Online.
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