Source: ET
Context:
The Council of Insurance Ombudsman (CIO) 2023-24 report highlights rising complaints against health insurers in India. Policyholders have increasingly approached the Ombudsman due to claim delays, partial or complete repudiations, and other service issues.
Key Highlights:
- Top Insurers by Complaints:
- Star Health & Allied Insurance – 13,308 complaints (10,000+ related to claim rejections)
- CARE Health Insurance – 3,718 complaints
- Niva Bupa Health Insurance – 2,511 complaints
- Public Sector Insurers in Top 5:
- National Insurance Co. Ltd – 2,196 complaints
- The New India Assurance Co. Ltd – 1,602 complaints
- Observation:
- The top three insurers with the most complaints are all stand-alone health insurers.
IRDAI Internal Ombudsman Initiative
- Objective: Resolve complaints for claims up to Rs 50 lakh internally within insurers.
- Scope: Handles complaints unresolved within 30 days or partially/wholly rejected complaints.
- Limitations:
- Excludes pending court, consumer forum, or Ombudsman cases.
- IO reports to the MD/CEO administratively, raising concerns about impartiality.
