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The Council of Insurance Ombudsman (CIO) 2023-24 Report

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Source: ET

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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.

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