Tips on filing a complaint for redressal of health insurance claims – CNBCTV18

Tips on filing a complaint for redressal of health insurance claims – CNBCTV18

If the insurance company or IRDAI fails to resolve your issue, you can escalate the issue to the ombudsman or approach the consumer court.
If you aren’t satisfied with the services provided by your insurer, or if your claim gets rejected due to wrongful reasons, you can approach the Insurance Regulatory and Development Authority of India (IRDAI) for a solution. There are several ways to reach the insurance regulator and escalate the issue further if IRDAI fails to solve your problem.
Here is how to file a complaint:
You first need to approach the grievance redressal office of the branch.
Your complaint must be given in writing along with associated documentation.
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You will be given a written acknowledgement along with the date of submission of the complaint.
Usually, the insurance provider must resolve the grievance within 15 days.
Tip: In case your complaint is not resolved within 15 days, the issue can be escalated to the IRDAI.
Here’s how to lodge a complaint against a health insurance provider with IRDAI
You must get in touch with the Grievance Redressal Cell of the Consumer Affairs Department of IRDAI via email or the customer care helpline.
After your complaint is lodged, you can use the Integrated Grievance Management System of the IRDAI to monitor your complaint and its progress.
You can also contact the Insurance Regulatory and Development Authority via letter.
Tip: You must contact the grievance cell or helpdesk of your health insurance company regarding your issue first. It’s only if your issue is not resolved within the specified time, that you should escalate the issue to IRDA.
Here are some additional channels and tips if your complaint is not resolved in time
You have the option to lodge a health insurance complaint through three main channels —Insurance ombudsman, IGMS, and finally, the consumer court.
Insurance ombudsman
An ombudsman is a government-appointed official who investigates the citizens’ complaints against government departments, financial institutions, business organisations and so on.
Tip: You can seek help from the insurance ombudsman to find a solution and escalate your complaint regarding the issue that has not been resolved by the insurance company.
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IGMS – Integrated Grievance Management System
The IGMS is an online platform of the IRDA. You can file a complaint against their insurance provider here and keep a track of the progress.
Tip: You are assigned a unique complaint ID when you file a complaint. This ID is issued to the relevant department as well for a quick resolution. The system also assigns a Turnaround Time (TAT) for all complaints registered and ensures an efficient complaint resolution.
Consumer court
If you fail to find a solution even after filing a complaint with the IRDAI, you can approach the consumer court and file a litigation against the insurance company.
Tip: The consumer court has a special division to handle health insurance complaints that can help you to efficiently resolve your complaint.
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