How to File a Complaint Against Your Health Insurer?

When you buy a health insurance policy, all you want is that policy to cover your planned and emergency medical expenses. It is disheartening to find your claim wrongly rejected or get a claim amount way less than what you expected. In fact, sometimes insurers refuse to renew the policy without a reason. If you are unhappy with the payout received from your insurance company, it is time to lodge a complaint.

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      Steps to File a Complaint Against Your Health Insurance Company Online

      Follow the steps given below to file a complaint against your health insurance company:

      Complaint Against Insurer

      Step 1 – Contact Your Insurance Company

      • File a written complaint with the Grievance Redressal Cell of your insurance company regarding the rejection of your health insurance claim.
      • Submit the required documents along with the complaint letter.
      • The insurer will acknowledge your complaint within 3 working days and resolve it within 2 weeks.
      • If the insurer rejects your claim again, they will specify its reason.
      • If you are not satisfied with the insurer's decision, inform them about your dissatisfaction before moving to the next step of grievance redressal. The insurer will mark the complaint as resolved if you do not notify them.

      Step 2 – Approach IRDAI's Grievance Redressal Cell

      • If you are unhappy with your insurer's decision, you can reach out to the Policyholder's Protection & Grievance Redressal Department of IRDAI (Insurance Regulatory and Development Authority of India).
      • You can register a complaint with the IRDAI's Grievance Redressal Cell using the Bima Bharosa system or by calling on 1800 4254 732 or 155255. You can also email on complaints@irdai.gov.in or send a physical complaint to IRDAI via post.
      • A token reference number will be allotted after you provide the requested details and the complaint is registered.
      • The IRDAI will forward your complaint to your insurer, who will resolve your complaint.

      Step 3 – Contact Insurance Ombudsman

      • If you are still not satisfied with the solution offered by your insurer, you can approach the insurance ombudsman of your jurisdiction.
      • The insurance ombudsman manages cases of up to ₹20 lakh and provides compensation to the aggrieved party.
      • The ombudsman will hear your complaint and, accordingly, provide a verdict.

      Step 4 – Appeal in the Consumer Court

      • If you do not agree with your insurance ombudsman's verdict, you can file a case with the consumer court.
      • Alternatively, you can move the consumer court directly after the IRDAI's resolution without reaching out to the insurance ombudsman.
      • The consumer court will hear the arguments from both sides and announce its decision.

      How to File a Complaint with Policybazaar?

      If you purchased your health insurance policy from Policybazaar, you can file a complaint in case of a problem. Check out the Policybazaar escalation matrix to file a complaint:

      Step 1 – Raise a Service Request

      • If you are facing a problem, you need to raise a service request with Policybazaar.
      • You can sign in to your account on Policybazaar.com and raise a service request through your My Account section.
      • You can also register your complaint on Policybazaar grievance email id, i.e. care@policybazaar.com
      • A ticket ID will be issued to you.
      • Your service request will resolved by the concerned team.

      Step 2 – Contact Your Head of Customer Services

        • If you are unsatisfied with the resolution, you can escalate your complaint to Policybazaar's Head of Customer Services.
        • Enter your Policybazaar complaint Ticket ID and other requested details to escalate the matter.
        • The Head of Customer Services will look into your complaint and suitably resolve it.

      Step 3 – Approach IRDAI

        • If you are not happy with the verdict of Policybazaar's Head of Customer Services, you can contact Policyholder's Protection & Grievance Redressal Department of IRDAI.
        • You can register a complaint with the Chief Grievance Officer of IRDAI Grievance Redressal Cell by calling on 155255 or 1800 4254 732 or sending an email on complaints@irdai.gov.in. You can also use the Bima Bharosa system on IRDAI's website or send a physical complaint to them via post.

      Which Types of Complaints Can Be Lodged Against the Insurer?

      The following types of complaints can be lodged against your insurer:

      • Delay in claim settlement beyond the time specified by IRDAI
      • Partial or total rejection of claims
      • Refusal to renew your mediclaim policy without a reason
      • Dispute on health insurance premiums payable
      • Non-issuance of a health policy after receiving the premium
      • Misinterpretation of terms and conditions in the policy document at any time
      • Disputes related to policy servicing
      • Issuance of a wrong policy that does not conform to the submitted proposal form
      • Legal construction of the health policy if the dispute relates to a claim
      • Any dispute regarding the violation of the guidelines issued by IRDAI

      FAQs

      • Q1. How do I complain about my health insurance company?

        Ans: You can file a complaint against your health insurance company by contacting the Grievance Redressal Cell of IRDAI. If you are not satisfied with the IRDAI’s resolution, you can reach out to the insurance ombudsman of your jurisdiction or move to the consumer court.
      • Q2. What is the IRDAI complaint email ID?

        Ans: The IRDAI email ID for filing complaints is complaints@irdai.gov.in
      • Q3. How to complain to IRDAI against an insurance company?

        Ans: You can raise a complaint to IRDAI against your health insurance company by:
        • Using the Bima Bharosa system on IRDAI's website
        • Calling on 1800 4254 732 or 155255
        • Writing an email on complaints@irdai.gov.in
        • Sending a physical complaint via post
      • Q4. Who can file a complaint with the insurance ombudsman?

        Ans: You can file a complaint with the insurance ombudsman of your jurisdiction if you are not satisfied with the solution provided by the Grievance Redressal Officer of your insurer.
      • Q5. What is the maximum claim amount for an insurance ombudsman complaint?

        Ans: The maximum claim amount for an insurance ombudsman complaint is ₹20 lakh.
      • Q6. How to take legal action against an insurance company?

        Ans: You can take legal action against your health insurance company by registering a complaint with the Policyholder’s Protection & Grievance Redressal Department, IRDAI. If the resolution provided by the IRDAI is not satisfactory, you can file a case with the consumer court or contact your insurance ombudsman.
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      Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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      *We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30- minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881.

      *Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.

      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

      **All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

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