The Insurance Ombudsman has released a report revealing the top insurers with the maximum number of grievances. The report provides insight into the performance of insurance companies in terms of customer satisfaction and complaint resolution.Some key points from the report include: 1. The names of the top insurers with the maximum grievances have been disclosed, allowing consumers to make informed decisions when choosing an insurance provider. 2. The report highlights the types of grievances received by the ombudsman, including claims-related issues, policy servicing, and premium disputes. 3. The data provides a comparison of the grievance rates among different insurance companies, enabling customers to assess the quality of service offered by each insurer. 4. The Insurance Ombudsman’s report also outlines the steps taken to address and resolve the grievances, ensuring that customers’ concerns are heard and addressed. 5. The release of this information aims to promote transparency and accountability within the insurance industry, ultimately benefiting consumers by encouraging insurers to improve their services and reduce grievances.

The Insurance Ombudsman’s Annual Report for 2023-24 has revealed a significant increase in complaints against health insurance companies in India. The report shows that the total number of complaints against health insurers rose by 21.7% to 31,490 in FY 2023-24, compared to 25,873 in FY 2022-23. Private insurers accounted for the majority of complaints, with 26,064 grievances, while public sector insurers accounted for 5,298.

Star Health & Allied Insurance led the list of companies with the most complaints, recording 13,308 grievances, of which 10,196 were related to claim repudiations. CARE Health Insurance and Niva Bupa Health Insurance followed with 3,718 and 2,511 complaints, respectively. The report also highlights that claim repudiation is the most common grievance, with the majority of complaints falling under this category.

The Insurance Regulatory and Development Authority of India (IRDAI) has responded to the rising dissatisfaction by mandating every insurer to appoint an Internal Ombudsman (IO) to review cases up to Rs 50 lakh that remain unresolved after 30 days or are rejected by insurers. However, experts argue that the independence of the IO is questionable since they report to the insurer’s top management, raising concerns about fairness and impartiality.

The report highlights the need for stronger accountability, transparency, and consumer protection in the health insurance sector. Policyholders are advised to look beyond premiums when buying health insurance and consider critical factors such as claim settlement ratio, repudiation rates, grievance redressal track record, and customer service quality.

The Council for Insurance Ombudsmen (CIO) has been established to provide policyholders with a speedy and cost-effective mechanism to resolve disputes against insurance companies. The CIO functions under the framework defined in the Insurance Ombudsman Rules, 2017, and serves as an alternative grievance redressal platform.

In conclusion, the report highlights the growing concerns of policyholders with health insurance companies in India. The rise in complaints and claim repudiations is a pressing issue that needs to be addressed by insurers and regulatory authorities. The appointment of Internal Ombudsmen is a step in the right direction, but its independence and effectiveness need to be closely monitored. Ultimately, informed choices and stronger regulation are key to restoring policyholder trust in the health insurance sector.