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Want to file a complaint against your health insurer? Here is how you can do it

If you feel that you have been cheated, not provided with adequate services, neglected, or have other grievances with your insurer than you have the right to file a complaint against them. Here are some of the ways in which you can do so.

1) Write to the insurer

Each insurance company is supposed to have designated Grievance Redressal Officers (GROs) whose contact details can be found on their websites in public domain. They are the first step people you should contact in case of a complaint. The process of filing the complaint is simple. You present your complaint in writing along with the documents supporting your case. And you receive a written acknowledgement of your complaint with the date.

The insurance company is supposed to amicably resolve the complaint within 15 days of receiving the complaint. If the company does not resolve the issue or the resolution is not satisfactory to you then you can use the route given below.

2) Contact the Consumer Affairs Department of IRDAI

There are various methods of approaching the Consumer Affairs section of IRDAI for complaint resolution:

  • You can call them at Toll Free Number 155255 (or) 1800 4254 732
  • You can send them an e-mail at complaints@irda.gov.in
  • You can send a complaint. Fill the complaint form available here.
  • Or you can make use of IRDAI’s online portal – Integrated Grievance Management System (IGMS) and Register and monitor your complaint at igms.irda.gov.in

3) Approaching the Insurance Ombudsman or civil court

If you are still not satisfied with the complaint resolution, you can take the final step of approaching the Insurance Ombudsman. There are currently 17 Insurance Ombudsman offices in the country and you can approach one based on the location of your insurer.

According to Ombudsman guidelines, You can approach the Insurance Ombudsman with a complaint if you have first approached your insurance company with the complaint and:

  • That has rejected it.
  • They have not responded for 30 days.
  • They have not resolved it to your satisfaction.
  • And the value of the claim is less than Rs. 30 Lakh.

The Ombudsman’s order should be complied with by the insurer within 15 days.

Photo by humberto chavez on Unsplash.

OneAssure is a distribution platform that helps you make right decisions on matters where health and finances converge. Visit oneassure.in to know more about your health insurance choices.


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