Once you have generated your letter using the button above, you can copy the text from the box below and proceed with the following steps to file your complaint.
Step 3: How to File Your Complaint with IRDAI
You can file your complaint with the IRDAI using one of these methods:
- Online (Recommended): Go to the IRDAI Bima Bharosa portal (IGMS) at bima.irdai.gov.in. Register your complaint, and paste the generated letter into the grievance description field.
- Email: Send an email to [email protected]. Use the "Subject" line from the letter as your email subject and paste the letter into the body.
Crucial: Remember to attach all supporting documents to your complaint (e.g., policy copy, denial letter from the insurer, correspondence, hospital bills).
Step 4: If Your Issue is Still Unresolved
The IRDAI (Bima Bharosa) portal is a grievance redressal system that compels the insurer to provide a final response. If you are still unsatisfied with the company's final decision (even after the IRDAI complaint), you have further options. Do not stop here.
Option 1 (Highly Recommended): The Insurance Ombudsman
This is your most powerful, cost-effective, and fastest option. The Ombudsman is a quasi-judicial authority who can pass a binding order (called an "Award") against the insurance company.
- Power: Can pass an Award up to ₹30 Lakhs. If you accept the Award, the insurer *must* comply within 30 days.
- When to Approach: You must approach the Ombudsman within one year of the insurer's final rejection letter.
- How: You must file a written complaint with the Insurance Ombudsman in your jurisdiction. You do not need a lawyer for this.
Option 2: The Consumer Court (Consumer Fora)
If you are not satisfied with the Ombudsman's decision, or if your claim is very large, you can file a case in the Consumer Court for "deficiency in service."
The system is divided by the value of your claim (pecuniary jurisdiction) as per the Consumer Protection Act, 2019:
- District Commission (DCDRC): For claims up to ₹50 Lakhs.
- State Commission (SCDRC): For claims between ₹50 Lakhs and ₹2 Crores.
- National Commission (NCDRC): For claims above ₹2 Crores.
Option 3 (Last Resort): Civil Court
You can also file a civil suit in a city civil court for breach of contract. However, this is almost always the last resort because it is extremely slow and expensive compared to the other options.
Understanding Your Grievance: A Detailed Guide with Examples
The following are hypothetical examples for illustrative purposes only, designed to help you identify the category that best fits your situation.
Claim Rejection: Alleged Non-Disclosure of PED
What it means: The insurer claims you hid a pre-existing medical condition when you bought the policy and is using this as a reason to reject your claim.
EXAMPLES
- You declared you had high blood pressure. Your claim for a heart procedure is rejected, with the insurer claiming you "hid the severity" of your condition, even though you provided all information requested.
- You were unaware of having a certain condition, so couldn't declare it. The claim is rejected, even though the condition was diagnosed for the first time during the hospitalization.
- The agent filled the proposal form on your behalf and intentionally omitted a condition you told them about. Now the company is blaming you for non-disclosure.
- Your claim for an accidental fracture is rejected because you failed to disclose you had diabetes, even though the two conditions are completely unrelated.
- You disclosed a "thyroid issue," but the claim is rejected because you didn't use the specific medical term "Hypothyroidism."
- A childhood illness that was fully cured 20 years ago and was not declared is used as a reason to reject a claim for a different, adult-onset illness.
- The insurer rejects a claim based on a doctor's remark in your old medical files which mentioned "suspected" or "borderline" condition, which was never formally diagnosed.
- You declared a condition to the agent over a recorded call, but it wasn't captured on the physical form, and now the company is denying any knowledge of it.
- Your claim is rejected for non-disclosure of a habit like smoking, even though the hospitalization was for a non-smoking related illness.
- The proposal form had a vague question like "Are you in good health?" which you answered "Yes" to, and this is now being used to reject a claim for a condition you were unaware of.
Claim Rejection: Deemed 'Not Medically Necessary'
What it means: The insurance company's internal doctors have decided that your hospitalization was not required, overriding the advice of your treating doctor.
EXAMPLES
- Your doctor admitted you for 2 days for observation and IV fluids due to severe dengue, but the insurer rejects the claim stating "treatment could have been done at home."
- After a minor surgery, your doctor kept you in the hospital for an extra day to monitor for infection due to your age. The insurer rejects the cost for the second day.
- You were admitted for severe food poisoning and dehydration which required continuous IV drips, but the claim is rejected as "not a medical emergency."
- A psychiatrist recommends hospitalization for acute anxiety, but the claim is rejected as "not requiring active line of treatment."
- Your child was hospitalized for high fever and convulsions, but the insurer denies the claim stating "stabilization could be done in the ER."
- A claim for a diagnostic procedure (like an angiogram) that required hospital admission is rejected because "no active treatment was given."
- You were admitted for pain management that required specialized equipment and monitoring, but the claim is denied.
- The insurer rejects a claim for an overnight stay after a day-care procedure, even though your doctor recommended it for post-operative care.
- An elderly patient is admitted for a urinary tract infection with complications, but the claim is rejected because "antibiotics could be taken at home."
- A claim for hospitalization due to a severe allergic reaction is rejected on the grounds that it was "only observational."
Claim Rejection: Based on policy exclusion/fine print
What it means: The claim is denied based on a clause buried in the policy document that was not clearly explained at the time of purchase, such as a sub-limit or a waiting period.
EXAMPLES
- Your claim for cataract surgery is rejected because of a 2-year waiting period for that specific procedure, which you were not aware of.
- Your policy has a sub-limit of ₹25,000 for a specific surgery, but your bill was ₹60,000. The agent had told you it was "100% covered."
- A claim for dental surgery due to an accident is rejected based on a general "dental treatment excluded" clause, even though accident-related treatment should be covered.
- Your claim is rejected because the treatment was "experimental" or "unproven," a term that is not clearly defined in the policy.
- A claim for bariatric surgery is denied because your BMI was 39, and the policy requires a minimum BMI of 40, a fine print detail you missed.
- Treatment taken outside India is rejected, even though the agent verbally promised "global coverage."
- A claim is rejected based on the "first 30-day waiting period," even for an illness that was not pre-existing and was diagnosed after 20 days.
- A claim for IVF treatment is rejected based on an "infertility exclusion," which was not highlighted during the sale.
- Your claim is denied because you were hospitalized for "evaluation purposes only," an exclusion hidden deep within the policy wording.
- A claim for robotic surgery is denied because the policy only covers "conventional" surgical methods, a distinction not explained earlier.
Claim Rejection: Alleged delay in document submission
What it means: The insurer is blaming you for being late with paperwork, even if you submitted everything on time or their requests were unclear or piecemeal.
EXAMPLES
- You submitted all hospital bills on Oct 1st (within the 15-day limit). On Oct 20th, they reject the claim, stating "documents submitted post-deadline." You have proof of submission (email timestamp, courier receipt) showing you were on time.
- The insurer sent a query for an additional document via a physical letter which reached you after the deadline to submit it had already passed.
- You submitted documents to the agent who sold you the policy, but they failed to submit them to the company on time, leading to a rejection.
- The company's online portal or app was down for maintenance near the submission deadline, preventing you from uploading documents, and they still reject the claim for delay.
- They claim non-receipt of documents that you sent via registered post, and you have the delivery confirmation from the postal service.
- A query was sent to an old, inactive email address, and the claim was rejected when you failed to respond in time.
- The deadline for submission was 15 days, but the hospital took 20 days to provide the detailed discharge summary, a factor beyond your control, yet the claim is rejected.
- The insurer keeps asking for one document at a time, each with a new 7-day deadline, effectively stretching the process for months and then rejects it citing overall delay.
- You were critically ill and unable to submit documents immediately after discharge, but the insurer rejects the claim without considering the genuine reason for the delay.
- The TPA confirms receipt of documents, but the insurer rejects the claim stating their head office never received the file from the TPA.
Claim Rejection: No valid reason provided
What it means: The company denies your claim with a vague, generic statement like "not payable as per policy terms" without citing the specific clause or providing a logical explanation.
EXAMPLES
- You receive a rejection letter that simply says "Claim denied. T&C apply," leaving you with no clear understanding of why it was rejected.
- The rejection email states the claim is "Repudiated based on internal underwriting guidelines," which are not part of the public policy document you signed.
- Customer service tells you on the phone that the claim is rejected but refuses to send you a written explanation or a formal rejection letter.
- Your claim is denied with the reason "insufficient documentation," but they do not specify which documents are missing or deficient.
- The rejection letter cites a policy clause number (e.g., "Rejected as per clause 4.3.b") but does not provide the text of the clause or explain how it applies to your case.
- Your claim is rejected with the reason "moral hazard" without any evidence or explanation of fraudulent intent.
- The cashless request is denied with a one-word reason like "Query" or "Pending" and no further clarification is provided for hours.
- The insurer rejects the claim stating "treatment inconsistent with diagnosis" without providing any medical evidence or doctor's opinion to support their statement.
- You receive an SMS saying your claim is rejected, with no follow-up email or letter explaining the reason.
- Your claim is rejected citing "information mismatch," but the company refuses to specify what information is mismatched between their records and your documents.
Excessive Delay in Final Claim Settlement
What it means: After submitting all required documents for a reimbursement claim, the insurance company has not processed the payment within the standard 30-day period mandated by IRDAI.
EXAMPLES
- You submitted your last document on Jan 15th. It is now March 1st, and the claim amount has not been credited, nor have you received any communication about a delay.
- The TPA (Third Party Administrator) approved the claim and informed you, but the payment from the insurer has been pending for over 45 days.
- Your claim was settled after 60 days, but the company refused to pay the mandatory interest for the period of delay as per IRDAI regulations.
- The claims team keeps telling you the file is "under process" for weeks without giving a specific timeline or reason for the hold-up.
- You receive an approval email, but the NEFT/bank transfer for the amount is not initiated for several weeks after the approval date.
- The company claims they sent a cheque that never arrived, and the process of re-issuing it takes another 30-45 days.
- Your claim file is repeatedly passed between different departments with no final decision.
- A small query is raised just before the 30-day deadline, resetting the clock, and this pattern continues with new minor queries.
- The company claims a "system error" or "technical issue" is preventing them from processing payments, an excuse they use for several weeks.
- Your claim is approved, but they state payment will be processed only after you submit a "satisfaction voucher," which is an extra-procedural delay tactic.
Unfair/Excessive Deductions from Claim (Partial Payment)
What it means: The insurer has paid only a portion of your total hospital bill, citing reasons like "non-payable items," "co-payment clauses," or "room rent capping" that you believe are being applied unfairly or incorrectly.
EXAMPLES
- Your bill was ₹1,00,000, but you only received ₹60,000. The deduction list includes items like gloves and syringes, which are essential for treatment and should be covered.
- Your policy states "No Room Rent Capping," but the company applied a proportionate deduction on all other charges because you stayed in a private room.
- A 20% co-payment was applied to your entire bill, but your policy states that co-payment is only applicable if treatment is taken in a non-network hospital.
- Charges for diagnostic tests (MRI, CT Scan) are partially paid with the reason "billed amount is higher than reasonable charges," without providing any official rate list.
- The cost of an implant used during surgery is deducted, with the insurer claiming it's a "non-medical expense."
- Doctor's visit fees are deducted because the doctor was a consultant and not a direct employee of the hospital.
- The insurer deducts a large amount under a vague heading like "Miscellaneous Charges" without providing a specific item-wise breakdown.
- You are charged for a "luxury tax" on the hospital room, which is then disallowed by the insurer.
- Costs for medicines are partially paid, with the insurer claiming that cheaper generic alternatives should have been used.
- A C-section delivery claim has deductions for the baby's charges, even though your policy explicitly includes newborn cover.
Unreasonable and repeated requests for documents
What it means: The insurer is intentionally delaying the process by asking for the same documents multiple times or requesting irrelevant paperwork in a piecemeal fashion.
EXAMPLES
- After submitting the discharge summary, they ask for daily doctor's notes. After you submit those, they ask for the original pharmacy bills, which were already submitted.
- They ask for an "implant sticker" for a surgery where no implant was used.
- The insurer asks for a 10th-grade mark sheet to verify age for an accident claim, even after you've provided your PAN and Aadhaar cards.
- They claim a submitted document is "illegible" without highlighting which part, forcing you to resubmit the entire set.
- You are asked for a "clarification letter" from a doctor on a minor point that is already clear in the discharge summary, just to delay the process.
- The TPA asks for a set of documents, and once you provide them, the insurer's main office asks for the same set again.
- They ask for your entire medical history file for the past 5 years for a simple, non-related claim like a fracture.
- You are asked to provide original bills via courier, and then they claim they never received them, asking for a new set.
- They ask for "indoor case papers," which hospitals typically provide directly to insurers, not to patients, causing a deadlock.
- A new document request is raised every 7-10 days, ensuring the claim processing clock is constantly reset.
Short Settlement of Pre/Post-Hospitalization Expenses
What it means: The company has either rejected or paid very little for expenses incurred on consultations, medicines, and diagnostic tests before or after hospitalization.
EXAMPLES
- You submitted bills worth ₹15,000 for post-hospitalization physiotherapy recommended by your surgeon, but the insurer only approved ₹2,000 without a proper reason.
- The costs of diagnostic scans done just before hospitalization, which confirmed the need for surgery, are rejected.
- Follow-up consultation fees with the surgeon after discharge are denied.
- Pharmacy bills for medicines prescribed at the time of discharge are rejected.
- The insurer only pays for medicines but rejects the cost of lab tests done during the post-hospitalization period.
- They claim the pre-hospitalization expense window is 30 days, but your policy document clearly states 60 days.
- Your claim for post-hospitalization expenses is rejected because you submitted it 15 days after the main claim was settled, even though you were still undergoing treatment.
- They disallow expenses on medical equipment (e.g., a walker or crutches) that were prescribed by the doctor for recovery.
- The insurer rejects pre-hospitalization bills from a different clinic, arguing they should have been from the same hospital where you were admitted.
- They apply a separate, arbitrary deduction on pre/post hospitalization bills that is not mentioned in the policy.
Denial of Cashless Facility at a Network Hospital
What it means: You went to a hospital that is listed in the insurer's network, but you were refused the cashless facility and forced to pay the entire bill upfront.
EXAMPLES
- At admission to a network hospital, the insurance desk informs you, "The insurer has stopped cashless services here," forcing you to arrange a large sum of money.
- The insurer rejects the pre-authorization request with a vague reason like "more information needed" and then becomes unresponsive, forcing you to pay.
- The hospital is on the insurer's main network list, but they claim it's not empaneled for a specific procedure you need.
- The TPA is unable to get a response from the insurer's approval team for hours, leading to the hospital demanding you pay directly.
- The insurer denies cashless, claiming the planned treatment is not covered, a decision they should have made after reviewing the claim, not before.
- Cashless is denied because your health card has a minor typo, even though your other government IDs prove your identity.
- The insurer has a payment dispute with the hospital, and as a result, all policyholders are denied cashless services without prior warning.
- You are told cashless is only for "emergencies," and your planned surgery does not qualify, which is against the rules.
- The insurer provides an initial approval for a small amount (e.g., ₹10,000) and then refuses to enhance it, forcing you to pay the balance.
- Cashless is denied for a newborn baby, even though the mother's policy includes a newborn baby cover.
Significant Delay in Cashless Pre-Authorization
What it means: The insurer or their TPA takes an unreasonably long time to approve the initial cashless request, causing delays in admission or discharge.
EXAMPLES
- The hospital sent the pre-authorization request at 10 AM, but the approval did not come until 8 PM, delaying your scheduled procedure.
- You are medically fit for discharge at 11 AM, but the final bill approval from the insurer doesn't arrive until 9 PM, forcing you to pay for an extra day's room rent.
- The insurer raises multiple queries one after another, each taking hours to resolve, effectively stalling the approval process for a whole day.
- The TPA claims they are "waiting for a doctor's opinion" for a standard procedure, a delay tactic that lasts for hours.
- The approval team is unresponsive on a weekend or public holiday, even though insurance is an essential 24/7 service.
- A request for enhancement of the cashless limit takes more than 6-8 hours to be approved.
- The insurer's system is down, and there is no manual backup process to approve cashless requests, leaving you stranded.
- You are forced to pay a large deposit to the hospital because the initial authorization is taking too long.
- The TPA keeps asking the hospital to resend documents they claim are "unclear," even when the hospital confirms they are perfectly legible.
- The approval is delayed because the insurer wants to investigate your previous medical history in the middle of a medical emergency.
Hospital Network Disputes (Blacklisting, Upfront Payment Demands)
What it means: The insurer is in a dispute with hospitals, leading them to be removed from the network without proper intimation to policyholders, or forcing hospitals to demand large upfront deposits from you.
EXAMPLES
- Your preferred hospital, which was on the network list last month, is suddenly no longer cashless because of a payment dispute between the hospital and the insurer.
- The hospital, despite being on the network, demands a large "refundable" deposit from you because they claim the insurer is unreliable with payments.
- The insurer's website still shows a hospital as a network partner, but when you arrive, you find out they were removed weeks ago.
- The hospital agrees to cashless but warns you that you will have to pay for any items the insurer "unfairly deducts," shifting the financial risk onto you.
- The insurer has blacklisted a major hospital chain in your city, severely limiting your choices for treatment, without informing you at the time of renewal.
- You are told the hospital is on the network, but only for certain procedures, not for the one you require.
- The hospital charges you "non-network" rates because they claim the insurer has not renewed their agreement.
- The insurer removes a hospital from the network while you are still admitted, causing chaos during discharge.
- A hospital is on the network, but they refuse to provide cashless services for any policies sold by agents, only for policies bought directly.
- The hospital's agreement with the insurer has expired, and neither party has bothered to update the public-facing network list.
Policy Renewal Issues (Sudden Premium Hike, Term Changes)
What it means: At renewal, the premium has increased exorbitantly without proper justification, or restrictive terms have been added to your policy.
EXAMPLES
- Your renewal premium has jumped by 60% this year, even though you made no claims and have not moved into a higher age bracket.
- The company adds a new 25% co-payment clause on all future claims for policyholders above 60 years at the time of renewal, without your explicit consent.
- Your policy's sum insured is downgraded or specific benefits are removed at renewal without a corresponding decrease in the premium.
- The insurer refuses to renew your policy after you filed a large but legitimate claim in the previous year.
- The renewal notice arrives just a day before the due date, leaving you no time to review or port out.
- The online renewal portal is not working, and customer service is unresponsive, putting you at risk of a policy lapse.
- A benefit like "restoration of sum insured" is changed from being available for any illness to only being available for unrelated illnesses.
- The premium for your family floater plan increased significantly because the insurer changed the age calculation method for the eldest member.
- You are forced to undergo a medical check-up for renewal, and based on the results, a massive loading charge is added to your premium.
- The insurer migrates you to a "new and improved" policy at renewal, which is actually more expensive and has fewer benefits than your old one.
Policy Cancellation without proper notice or reason
What it means: The insurance company has cancelled your policy without sending you a formal, registered notice at least 15 days in advance, or without providing a valid reason like proven fraud.
EXAMPLES
- You discover your policy is inactive when you try to use it, and customer service informs you it was "cancelled last month," but you never received any official letter or email about it.
- Your policy is cancelled with the reason "non-disclosure," but the company refuses to provide any evidence of what was not disclosed.
- The policy is cancelled because a renewal cheque bounced, but the company did not inform you or give you a chance to make the payment through another method.
- An agent fraudulently cancels your policy in order to sell you a new one from a different company.
- Your policy is cancelled mid-term without a refund of the pro-rata premium.
- The company claims they sent a cancellation notice to an old address, even though you had officially updated your contact details with them.
- Your policy is cancelled because you filed multiple small claims, even though none of them were fraudulent.
- A group policy provided by your employer is cancelled, but no option for migration to an individual policy is provided to you.
- The policy is cancelled citing a "material change in risk," a vague reason that is not explained further.
- You receive a cancellation notice, but it does not provide the mandatory 15-day notice period, making the cancellation invalid.
Incorrect Policy Details (and refusal to correct)
What it means: Your name, age, or other critical information is wrong on the policy document due to an error by the agent or company, and they are refusing or endlessly delaying the correction process.
EXAMPLES
- Your date of birth is incorrect on the policy, and despite sending your PAN and Aadhaar card copies multiple times, the endorsement has not been done for months.
- Your name is misspelled, which you fear will cause problems during a claim, but customer service keeps saying "it's a minor issue."
- The nominee's name is incorrect, and the company is taking months to issue a corrected policy document.
- Your communication address is wrong, so you are not receiving any physical mail from the insurer, and they are not correcting it despite requests.
- The agent entered the wrong details for one of the family members in a floater policy.
- You requested a change in your name after marriage, submitted all legal documents, but the policy still shows your old name.
- The policy shows the wrong sum insured, different from what you paid the premium for.
- A correction request is repeatedly closed without any action being taken, forcing you to raise a new request each time.
- The company asks you to pay an "endorsement fee" to correct a mistake that they themselves made.
- The corrected policy document is issued but contains a new, different error.
Difficulties in Policy Portability
What it means: You are trying to switch your health insurance to or from the company, but the process is being delayed, or your continuity benefits are not being correctly transferred.
EXAMPLES
- You applied to port your policy from another insurer 45 days before renewal, but the new insurer has not made a decision, jeopardizing your continuous coverage.
- Your current insurer fails to provide your policy details and claims history to the new insurer in time for them to process your portability request.
- Your portability request is accepted, but your continuity benefits for pre-existing diseases are not applied, and the new policy treats you as a fresh customer.
- The company imposes a huge premium loading charge on your portability application, making it unaffordable.
- Your portability request is rejected without a valid reason, or with a vague reason like "adverse claims history" when you have made no claims.
- The company deliberately delays the portability process so that you miss the renewal deadline and your policy lapses.
- You are told you can port your policy, but only to a much inferior plan with fewer benefits.
- The agent advises you to cancel your old policy and buy a new one instead of porting, causing you to lose all your accumulated benefits.
- The company refuses to port a family floater policy unless every single member undergoes a fresh medical check-up, including young children.
- There is a long and unexplained silence from the company after you submit your portability application and documents.
Mis-selling of Policy by Agent
What it means: The sales agent made false promises or misrepresented the policy's benefits to get you to buy it.
EXAMPLES
- The agent promised that maternity expenses would be covered after one year, but the policy document clearly states a waiting period of three years.
- The agent sold you an "inpatient only" policy by describing it as a "comprehensive plan with OPD cover," which is untrue.
- You were told there are "no hidden clauses," but after a claim, you discover a major sub-limit for specific surgeries that makes the cover inadequate.
- The agent promised "coverage from day one for all diseases" by hiding the concept of waiting periods for pre-existing diseases.
- You were sold a policy by being told it has a "lifetime renewal guarantee," but the fine print allows the company to reject renewal under certain conditions.
- The agent convinced you to port your existing policy by promising a lower premium, but the new policy has far fewer benefits and more restrictions.
- You were told your policy covers domiciliary (at-home) treatment for any illness, but the policy only covers it for a specific list of three conditions.
- The agent filled the proposal form for you and ticked "No" to all medical history questions despite you telling him about your conditions, saying "don't worry, it doesn't matter."
- You were shown a brochure with a list of 1000 hospitals, but the actual network list for your specific policy variant is much smaller.
- The agent claimed the policy includes a "no claim bonus" that doubles the sum insured in 2 years, whereas the actual rate is a slow 10% per year.
Rude, Unprofessional, or Abusive Behavior from Staff
What it means: During your interactions with customer service, claims department, or sales agents, you have been treated with disrespect, been mocked, threatened, or spoken to in an abusive manner.
EXAMPLES
- When you called to check your claim status, the representative shouted at you and disconnected the call.
- During a call, an employee mocked your medical condition, saying, "People like you are the reason premiums are high."
- An agent threatened that if you don't renew immediately, he will ensure your data is marked "high-risk," making it difficult to get insurance elsewhere.
- A customer service representative laughed when you were explaining your serious medical problem.
- An employee used abusive or profane language during a phone conversation.
- You were put on hold for an hour, and when the representative returned, they pretended they couldn't hear you and hung up.
- A claims investigator spoke to your neighbors and revealed your sensitive medical information, which is a breach of privacy.
- An agent made a discriminatory remark based on your age, gender, or location.
- A representative repeatedly cut you off and did not allow you to explain your issue completely.
- You were told, "If you are so unhappy, you can go to court. We are not afraid," in a threatening tone.
Harassment via Spam/Marketing Calls (despite DND)
What it means: You are receiving repeated, unwanted marketing or renewal calls from the insurer or its representatives even after registering on the DND registry.
EXAMPLES
- You receive 3-4 calls every day from different numbers trying to sell you a new policy, even after you've told each caller you're not interested and are registered on DND.
- You receive aggressive tele-calling for renewal a full two months before the due date, with callers creating a false sense of urgency.
- After porting out from the insurer, you continue to receive marketing calls from them on your DND-registered number.
- You receive promotional WhatsApp messages and SMS spam from the company without your consent.
- An agent calls you at odd hours, such as late at night or early in the morning.
- You block one number, but they call you back from a different number within minutes.
- The caller refuses to identify themselves or the company they are calling from until you have answered several questions.
- You are added to marketing email lists that you cannot unsubscribe from.
- An agent shows up at your home uninvited to try and sell you a policy.
- You receive calls about your "lapsed" policy, even though it is active and fully paid up.
Suspected Fraud by Agent or Intermediary
What it means: You believe the agent has acted fraudulently, for instance, by pocketing a part of your premium, making unauthorized changes to your policy, or issuing a fake policy document.
EXAMPLES
- You paid a premium of ₹20,000 to the agent, but the official policy document shows a premium of only ₹18,000.
- The agent took cash from you but never deposited it with the company, and you never received a policy.
- You discover that the agent has made himself the nominee on your policy without your knowledge.
- The agent filled the proposal form with false information to make sure the policy was issued quickly.
- You receive a policy document that looks fake and does not show up on the insurer's official website when you try to verify it.
- The agent convinces you to cancel your existing policy and buy a new one by providing false information, just to earn a commission.
- You find out the agent has used your details to buy a policy for someone else.
- The agent provides you with a fake medical receipt to submit with your claim.
- You paid for a sum insured of ₹10 lakhs, but the policy was issued with only ₹5 lakhs, and the agent pocketed the difference in premium.
- The agent took your signature on a blank form and then filled it out with details you did not provide.
Unresponsive Customer Service (No Email Reply, Long Hold Times)
What it means: Your attempts to contact the company for help are futile. Emails go unanswered, calls are put on hold indefinitely, and there is no way to get a clear answer to your query.
EXAMPLES
- You sent an email with an urgent query a week ago and have sent two reminders, but have only received an automated ticket number with no human response.
- The customer service phone number is constantly busy or rings without anyone picking up.
- You are put on hold for over 30 minutes, after which the call gets disconnected automatically.
- The online chat support is always offline or is operated by a bot that cannot answer your questions.
- You visited a branch office, but the staff there told you they cannot help and you have to contact the head office via email.
- Your email is bounced back with an "undeliverable" error, indicating the customer service email address is not working.
- You get a reply, but it's from a "no-reply" address, so you cannot continue the conversation.
- The customer service representative promises a "call back within 24 hours," but you never receive one.
- Different representatives give you conflicting information each time you call.
- You are repeatedly transferred from one department to another, with no one taking ownership of your issue.
Ineffective Grievance Redressal (Generic/Copy-Paste Responses)
What it means: Even when you file a formal complaint with their grievance cell, the response you receive is a generic, templated reply that does not address the specific points of your problem.
EXAMPLES
- You wrote a detailed complaint about an unfair deduction. The reply you received was a standard email stating, "We have processed the claim as per policy terms and conditions," without explaining the deduction.
- You complained about an agent's rude behavior, and the response is, "We regret the inconvenience caused. Your feedback is valuable to us," with no mention of any action taken.
- Your complaint is closed without your consent, with the resolution listed as "Explained to customer," even though you are still dissatisfied.
- The grievance officer's reply simply repeats the same reason for rejection that the initial claims team gave, without any re-evaluation of your case.
- You provide extra documents to support your complaint, but the reply you receive is identical to the one you received before submitting the documents.
- The response to your complaint about a delay is, "We are expediting your case," a promise that is repeated for weeks without any actual progress.
- You complain about a system glitch, and the response is, "Please clear your browser cache and try again," ignoring the core technical problem.
- The grievance cell takes the full 15 days to reply, and the reply is just a request for more documents that could have been asked for on day one.
- The response is signed by a "Grievance Redressal Team" with no name or contact details of a specific officer you can follow up with.
- You complain about mis-selling, and the company's response is to simply send you a copy of the policy document's terms and conditions.
App/Website Glitches (Login Failure, Document Upload Error)
What it means: The company's digital platforms are faulty, preventing you from managing your policy, submitting documents, or accessing information.
EXAMPLES
- You are trying to upload your reimbursement bills on the app before the deadline, but you keep getting a "File Size Too Large" error even for small files, or the app simply crashes.
- The "Forgot Password" link does not work, so you are permanently locked out of your online account.
- The website does not show your active policy, or shows incorrect details about it.
- You are unable to download your policy document or health card from the digital portal.
- The online premium payment page fails after you enter your card details, but the amount gets debited from your account without a receipt being generated.
- The list of network hospitals on the app is outdated or inaccurate.
- You submit a claim through the portal, but it does not reflect in their system, and there is no confirmation number provided.
- The app keeps logging you out every few minutes, making it impossible to complete any task.
- The document upload feature does not allow you to upload more than one file at a time, making the process tedious for multiple bills.
- You update your contact details on the portal, but the changes are not saved, and the system continues to use your old information.
Data Privacy Breach (Suspected Sale or Misuse of Data)
What it means: You have reason to believe that your personal and sensitive medical data has been compromised, sold, or shared without your consent.
EXAMPLES
- A week after buying a policy, you start receiving calls from other financial service companies who know your policy details and medical history.
- You receive a phishing email that looks like it's from your insurer, asking for OTPs, which suggests a data leak.
- A third-party agent calls you and offers a "better deal" by pointing out the specific shortcomings of your existing policy, information he should not have.
- You find your policy details, including your phone number and email, on a public website that seems to be illegally hosting insurance data.
- Another company's agent contacts you and mentions the exact premium you are paying for your policy.
- You receive marketing calls for health services (e.g., from labs or pharmacies) that are related to a medical condition you have only disclosed to your insurer.
- An agent from a competing firm tells you they "got your number from an industry database."
- Your nominee receives marketing calls, even though their contact details were only provided to the insurer for nomination purposes.
- You discover an online complaint from a former employee who alleges that the company regularly sold customer data.
- The company suffers a data breach, but fails to inform you in a timely and transparent manner.