IRDA complaint - Health & Life Insurance Complaints

Insurance Complaints

Insurance is a means of protection from financial loss. It is a form of risk management primarily used to hedge against the risk of a contingent or uncertain loss.

It’s one of the most prominent things that ensures the user that they will be saved from a major burden. 472 million people in India have health insurance. Source

Insurance is usually brought as it gives peace to the mind of the holders. There are two types of insurance namely life insurance and general insurance. The life insurance offers compensation in case of death or disability whereas general insurance offers compensation in scenarios other than death.

Life insurance can be divided into term life, pension plans, money-back policy and unit-linked insurance plans. General insurance can be divided into motor insurance, home insurance, health insurance and fire insurance.

But no one knows what will happen next and what if you get trapped in an insurance scam? Or you are not happy with your insurance company?

Many people don’t know the exact route to file a complaint against their insurance company and often get confused about consumer rights but this article will tell you:

- What are the insurance complaints?
- Famous insurance companies in India
- Types of Insurance complaints
- How to resolve the complaints?

Yes, this article will answer all your questions. Let’s start with what exactly an insurance complaint is?

The 2017 notification on the protection of policyholders defined ‘insurance complaints’ as a written expression of dissatisfaction made by the complaint against an entity like the insurer, agent or broker.

The complaint can be about an action or lack of action, the standard of service, or deficiency of service.

Now let’s see some of the famous insurance companies in India.

Famous Insurance Companies In India

India has 57 insurance companies out of which 24 are life insurance. The following are the top 10 companies in India.

1. LIC: Life Insurance Corporation of India: LIC is the most heard insurance corporation of India. It is an investment corporation owned by the government of India and is an Indian state-owned insurance group. Having headquarters in Mumbai, It was founded on 1st September 1956 when the life insurance of India act was passed and the insurance industry of India was nationalized. They have settled 26 million claims in 2018-19 and have a total life fund of 28.3 trillion. LIC was rated as the 6th most trusted service brand of India by the Economic times brand equity survey of 2012.

2. ICICI Prudential Life Insurance: Can you guess what was the first insurance company to be listed on the Indian stock exchange? This company was the first insurance company in India to be listed on the Indian stock exchange. They started in 2001 and currently have $14 billion in assets under management. They offer long term insurance plans and work in the financial service sector.

3. HDFC Standard Life Insurance: This is a joint venture between a housing development finance corporation and standard life Aberdeen. Having headquarters in Mumbai, HDFC now has 421 branches in 980+ cities and towns in India. In 2012, it became the first private life insurance company to bring back pension plans under the new regulatory regime, with the launch of two pension plans which are HDFC Life Pension Super Plus and the HDFC Life Single Premium Pension Super.

4. Max Life Insurance: This company is a subsidiary of the public listed company called Max financial services. After the liberalization of the insurance sector, this company was founded in 2000 while the operations began in 2001. Their headquarters is in New Delhi.

Banks, individual agents, brokers, and corporate agents are some of Max Life's distribution channels. It provides linked participating and non-participating products. It also covers health, pension, and annuity. Child, protection, retirement, savings, and growth plans are offered to individuals and groups.

5. SBI Life Insurance: SBI is the largest state-owned bank in the country and SBI life insurance is the joint venture of the state bank of India and BNP Paribas. It is a public limited company and was founded in 2001. SBI Life Insurance has an authorized capital of 20 billion (US$280 million) and a paid-up capital of 10 billion (US$140 million).

6. Bajaj Allianz General Insurance: This is a joint venture between Bajaj Finserv and Bajaj Auto. It offers financial planning and security. Founded in 2001 they have headquarters in Pune, Maharashtra. To conduct general Insurance business in India Bajaj Allianz Life Insurance received a certificate by the Insurance Regulatory and Development Authority (IRDA) called the Certificate of Registration on 3 August 2001.

7. Tata AIA Life Insurance: Major Insurance companies are joint ventures and so is this. Founded in 2001 they currently have headquarters in Mumbai. The organization offers general insurance. Energy, Marine, Property, and specialized Financial covers are being covered by The commercial sector. Insurance for Automobiles, personal accidents, casualty, home, health, and travel are some of the services that the consumer insurance service offers.

8. Reliance Nippon Life Insurance: This is one of the most prominent insurance companies in India. This is a joint venture and was founded in 2001. They have their headquarters in Mumbai. The company achieved a profit of Rs. 3.80 billion. 760,000 policies were sold during 2012–13 with total managed funds valuing at Rs. 181.89 billion, They managed to do this through a wide network of distribution with 1,230 offices and over 124,000 advisors.

9. Bharti AXA General Insurance: This is a joint venture between Bharti Enterprises and Axa business group. They started their operations in 2008 and currently have 104 branches around the country. They offer various products catering to retail, rural, and commercial clients. Broadly, it offers insurance for motor and two-wheeler insurance, health and critical illness, property, student and individual and family travel, crop insurance, and commercial lines.

10. Aditya Birla General Insurance: This was established in 1994 as a joint venture between the Aditya Birla Group and Sun Life Financial of Canada. Founded in 1994 they are currently serving in 26 countries.

Yes, all these were some of the most famous insurance companies in India but everything’s famous is not always good! Is it? There could be thousands of arising problems and you can be unhappy with an insurance company for various reasons.

So let’s see some of the major types of insurance complaints that are seen among the people.

Types of Insurance Complaints

1. Policy maturity issues: Plenty of people at voxya have reported that their policy has matured but the amount has not been credited in their bank accounts yet. It is usually the refusal of an insurance company to honor a request by an individual. This is one of the most common issues reported by consumers from Mumbai, Pune, Bangalore, New Delhi, Kolkata etc, at the Voxya website.

2. False commitments: This happens a lot of times if the person taking the insurance is not checking all the formalities carefully. Misrepresentation in paper works is very easily possible and takes place on a very wide scale. Also, many times insurance agents are committing wrong details of the policy in order to get sales and meet their sales target. Thus one needs to read all the paperwork carefully and clear all the concerns carefully before taking any insurance or buying any other service in general.

3. Delays: This is also one of the most common insurance complaints seen. There can be delays in listening to your concerns or in taking an action. Even Though sometimes this issue can arise because of some internal defect but if the settlement or processing of a claim does not take place in some time then it can cause problems.

4. Unsatisfactory claim settlement: If delays are not affecting you then it can be an unsatisfactory claim settlement. We don’t always get what we demand and most of the time it can be irritating for the consumers. This happens mostly in health or medical insurance where claims are not settled in full by the insurance company. Again this type of comlpaint has been reported in almost all the major cities like Bangalore, Pune, Mumbai, Kolkata, New Delhi etc.

5. Wrong Treatment: Do you like rude behavior? No one does! Not getting your concerns listened to or just being not behaved properly can make people dislike a company. Therefore creating a good relationship with the consumer is very important.

6. Negligence: This means the failure to take proper care of something. The law of negligence requires individuals to conduct themselves in a way that conforms to certain standards of conduct. If a person does not conform to that standard, the person can be held liable for the harm he or she causes to another person or property.

As we have seen the most possible insurance disputes let’s see how you can resolve them.

How to Resolve Insurance Complaints?

Step 1: File a formal complaint with your Insurer
You can send a written complaint to your insurer with all the supporting documents that you have. The contact details of all the insurance companies are available on their policy documents or their website contact pages. You can also find all of their contact details on the Insurance Regulatory and Development Authority (IRDA). The helpline number of some leading insurance companies in India are :

LIC Customer Care Number - 022 6827 6827
ICICI Prudential Life Insurance Customer Care Number - 1860 266 7766
Reliance Life Insurance Customer Care Number - 022 4882 7000
Bajaj Allianz Customer Care Number - 1800 209 5858
Birla Sun Life Customer Care Number - 1800 270 7000
SBI Life Insurance Customer Care Number - 1800 267 9090
Max Life Insurance Customer Care Number - 1860 120 5577
HDFC Standard Life Customer Care Number - 1800 22 7227
Tata AIA Life Insurance Customer Care Number - 080676 03700

The Insurance company should address your issue in 15 days, in case of not getting the issue resolved or if you are not satisfied with the solution, you can complain to the IRDA.

Step 2: Register a complaint with IGMS (Integrated Grievance Management System) of IRDA
Once your complaint is registered you will be allotted a token reference number and you can use that number to monitor the complaint. You should visit http://igms.irda.gov.in for taking action.

Step 3: Contact an Ombudsman
Ombudsman is an official who, usually appointed by the government who investigates complaints against businesses, financial institutions, or government departments or other public entities, attempts to resolve the conflicts or concerns raised, either by mediation or by making recommendations.

The official demands evidence and all the necessary information to understand the case better and see it from the eyes of both parties. They do a full assessment and give their final assessment.

Step 4: Take legal action against your Insurance company
If nothing works out well you still have the doors open for the consumer court. You can send legal notice to the insurance company if it is unable to resolve your complaint. It is one of the efficient ways to handle the issue legally.

Check below to know how to send a legal notice to the insurance company?

i) Firstly, get a legal notice drafted by a lawyer.
ii) Check it properly and make sure it is signed by a lawyer.
iii) Keep a copy of it for future purposes.
iv) Send the legal notice to the insurance company by registered post.
v) Keep the slip or delivery report for evidence.

Step 5: File consumer forum case
Consumer forum deals with consumer complaints and you should approach consumer forum if you feel that your rights as a consumer have been violated. If an insurance company is not responding to your complaints even after sending legal notice by a lawyer then you should file a case against it in a consumer court.

Here is how you can file a case in the consumer court?

Step 1: Intimate the aggrieved party via legal notice.
Step 2: Draft the consumer complaint
Step 3: Attach all the relevant documents and proofs to support your complaint.
Step 4: Select the appropriate court for filing the complaint.
Step 5: Pay the prescribed court fee that is required to be paid along with the complaint.
Step 6: Submit the case along with the affidavit & fees in the court.

Points to Remember:
Make sure you have complained to the relevant insurance company before approaching the IRDA.
The IGMS system allows the policyholder to amend his complaint midway.

If you are finding all this information overwhelming and can’t manage to do it all alone then let Voxya help you strengthen your voice and solve insurance disputes on your behalf.

Voxya is a unique platform for resolving consumer complaints against brands quickly. We help consumers in fighting against injustice, fraud, and lousy customer service.

We use social media, business networks, and legal frameworks to resolve consumer disputes. We take every consumer complaint personally and ensure that we do everything that we can to get the consumer complaints resolved.

So why take so much trouble, if you have the solution just some clicks away!
Get your complaint resolved. File your Insurance Complaint at Voxya now!

Most Common Issue Reported for Insurance Complaints

Policy issues

Policy maturity issues

False commitments

Fake insurance policy

Insurance not received (National Insurance Company) ^Open

I paid pm pasalabheema yojana on paddy crop **** august **. It got damaged due to titili cyclone but inc not paid my crop insurance amount. My crop fully damaged. But the company did not pay still now....

Sep 02, 2019 by BALLEDA RAMARAO

Max life term plan has not modifying the plan as promised (Max Life Insurance Co Ltd) ^Open

As promised by coverfox on behalf of max life insurance the current policy will get modified to the future policy having maturity includes the paid tenure period or else will get a refund for the paid tenure. Most importantly they are not even ...

Sep 02, 2019 by Manish Jain

Breach of health insurance contract (Religare Health Insurance) ^Open

I have purchased a health insurance policy from Religare health insurance my sum insurance was * lakh. Before taking the policy I have disclosed all my health condition. In the handbook, if Religare it is clearly mentioned any type of decease w...

Aug 28, 2019 by Moloy Acharjee

My bajaj allianz policy number not matched (Bajaj Allianz General Insurance) ^Open

My policy number not my name match. Plz action broker sankar debnath. ...

Aug 25, 2019 by Suraj deb

Mobile insurance claim (Dymaje) ^Open

When I tried to claim the insurance they say I have to register in ** hrs and neither you are giving me an option for *nd claim as said in the policy. I was inquiring about policies but the contact number was not working due to technical issue...

Aug 24, 2019 by Palash Raut

Insurance claim not satisfactory (Lic Of India) ^Open

I have purchased Health insurance policy from LIC of India . But its not supporting me at the time of claim . the company saying below statement. " Plan is *** , JEEVAN AROGYA. Jeevan Arogya policy is a fixed benefit Policy and selected benefi...

Aug 24, 2019 by Prasannakumar chowdary

Extra amount paid in the name of insurance for mobile and didn't get refund (Bajaj Finserv) ^Open

I bought a mobile from Vivek Adyar Chennai. Bajaj finance offered EMI options and they got a payment of **** and said it will be refundable. I asked the reason they said it is insurance. But still, I didn't get the refund. When I approached the...

Aug 12, 2019 by Keerthika D

Wrong settlement of mediclaim policy (Bajaj Allianz General Insurance Company Ltd.) ^Open

Sub. Wrong settlement of the cashless claim of my wife Kumkum Bhagoliwal Ref. *- Order No: HAT/**/******* *- Claim No: OC-**-****-****-******** Kindly refer to your mail dated **th April **** on the above-mentioned subject statin...

Aug 06, 2019 by Dr. Ajay Bhagoliwal

Fraudulent sale for insurance (Hdfc) ^Open

I have an exidelife policy which has lapsed. Based on the policy I had a call from Piyush Mehra from Delhi stating that he is from exidelife and advised me to pay some amount towards the policy to get additional money. I did. I have details of ...

Jul 08, 2019 by LIONELL ELLIS

Accident claim not given (Bajaj Allianz General Insurance Company Limited) ^Open

My vehicle was parked in parking at Murthal. Early morning I saw that there were scratches on left and front glass was broken. When I contacted my insurer Bajaj Allianz. They refused to give me the whole claim....

Jul 06, 2019 by Pankaj kumar

Regarding health insurance (Star Health And Allied Insurance Co.) ^Open

I herewith submitting all reports related to my treatment in Apex Hospital through star health card. I took treatment for * days i.* from **/**/**** to **/**/****. Star health has cheated me by rejected my claim reimbursement claim No. CLI/****...

Jul 01, 2019 by MOHAMMED JAHANGIR

Claim of accident car by insurance company (Future General India Insurance Company Limited) ^Open

Future general india company ka md meri accidents car ka claim pass nhi kar rah hai. Usne claim ke liye mana kar diya hai. Bar bar dauda raha hai. Please help kariye. Mai is cheap company ke jhanse me aa ke fans gaya hoon. Please help me mera c...

Jun 29, 2019 by Gaurav Prakash Singh

Wrong vehicle insurance issued (Reliance General Insurance) ^Open

Complainant complaints under policy no. ****************** purchased online on *th June ****, that the insurer has given a discount of Rs. ****.** by mentioning "Vehicles specially designed/modified for the blind, handicapped and mentally chall...

Jun 25, 2019 by Vijay Chaudhary

Malpractice by LIC of India (L I C) ^Open

RDA Token Number: **-**-****** *. Complain to IrDA against LIC to issue single premium policy was registered on **/**/****. *. Date of dispatch of the bond by LIC is **/**/**** as per LIC letter no: HDO/CRM/cpgram/****/** date.**.**.**** and ...

Jun 22, 2019 by Ashok kumar prajapat

Unacceptable increase in ROI for home loan and home insurance account (Hdfc Limited) ^Open

Unacceptable increase in ROI for a home loan and home insurance account nos. *********/*********. Grievance on Home loan a/c ********* - *. Why an increase is made after every RBI increase in base points but decreases never happens? *. I t...

Jun 04, 2019 by Ankur Agarwal

Car insurance rejected (Royal Sundaram General Insurance Co. Limited) ^Open

My Honda Jazz car engine got damaged due to oil sump breakage and engine oil leakage from it. This was due to an external impact on the oil sump caused by some stones on bad roads near Gachi Bowli on *th, March **** around * pm. The car was to...

May 29, 2019 by Battu Sridevi

Car accident claim is not approved completely (Reliance General Insurance) ^Open

I have a car policy with Reliance General Insurance with policy no - ******************. My car met with an accident on **th May ****. While taking a right turn on a four-lane road, another car while crossing the road banged into the front doo...

May 28, 2019 by Rushiraj Waghela

Insurance claim not received (HDFC ERGO General Health Insurance Co. Ltd) ^Open

(Formerly HDFC General Insurance Limited). Registered & Corporate Office: *st Floor, HDFC House, ***-*** Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – *** ***. Customer Service Address: D-***, *rd Floor, Eastern Business Distri...

May 27, 2019 by Ajay Kumar

LIC agent is not collecting premium since last 5 quarters (LIC) ^Open

LIC agent is not collecting premium since the last * quarters. Now for the revival of my policy I've to pay a penalty of Rs. ***.**. I've been calling the agent frequently to collect the premium but the agent doesn't show up. Now I've to pay a ...

May 25, 2019 by Heena Khandelwal

Declined my claim (Religare Health Insurance) ^Open

I am writing this email to express my utter disappointment on the cashless disapproval of my health insurance claim for my admission to Artemis Hospital in Gurugram from **/**/**** to **/**/**** for treatment and workup of my ongoing severe hea...

May 24, 2019 by Vikas Samota