Taran Saini 10 July 2021
srishti jain 02 August 2021
According to the scenario you have mentioned, let me brief you about the procedure, to file a complaint against a health insurer.
If your insurance agent or HR department cannot help resolve your problem within 30 days, call the insurance company yourself. If a person denies your claim, you can file a complaint.
Before complaining against the health insurance provider, you have to approach the Grievance Redressal Office of the branch. The complaint has to be given in writing with associated documentation. A written acknowledgement will be given to you along with the date of submission of the complaint. Generally, the insurance provider has to resolve the grievance within 15 days. In case this does not happen, the issue can be escalated to the IRDA. It has laid down a Turnaround Time (TAT) for the various services rendered by insurance providers to the insured.
To lodge a complaint against a health insurance provider with the IRDA, you have to get in touch with the Grievance Redressal Cell of the Consumer Affairs Department of IRDA via email or customer care helpline. Once the complaint is filed, you can use the Integrated Grievance Management System offered by the IRDA to monitor your complaint and its progress. You can also contact the IRDA via letter or fax. If the issue is not resolved, you can escalate the issue to IRDA.
Hope it helps,