Have you ever faced a situation where you are dissatisfied by the service provided by your health insurance company? There are many situations where you are unhappy with the service of your health insurance service provider. For example, you have paid the premium and not received the policy document. The insurance company rejects your claim totally or partially. Sometimes there may be inordinate delays in receiving the settlement claim. Have you discussed and debated till you were blue in the face, and still did not get a satisfactory settlement of your health insurance claim. If so, where did you seek redressal of your complaint?
The Grievance Redressal Cell (GRC) in the Consumer Affairs Department of the Insurance Regulatory and Development Authority of India (IRDAI) is one of the places you could go to with your complaint as a health insurance policyholder. What is more, the GRC prefers that policyholders or the claimants themselves approach them for resolution of the complaint. Complaints by third parties, agents or advocates are not entertained.
Procedure for Lodging a Complaint
1. Make Sure You Have a Valid Complaint
It may often happen that the coverage terms and conditions as specified in the policy document are different from what you had bargained for. Very often, you find yourself buying health insurance policy on the basis of a brochure with some bullet points and the canvassing skills of the agent. Once the policy document actually arrives, the fine print may defer from your original understanding. So be sure to read the policy document on its arrival, so that you are aware of what the policy assures and under what terms and conditions it does so.
2. Approach the Grievance Redressal Cell of the Medical Insurance Company in Question
Having understood the precise conditions under which you can make a claim under your medical insurance policy, should you feel that your medical insurance service provider has not delivered services as per the terms and conditions of the policy, you must first approach the Grievance Redressal Cell of the medical insurance company in question. The GRC is expected to respond in a reasonable period of time – this is a maximum of fifteen days. Make sure that you keep a copy of the complaint and get a written acknowledgment from the office concerned. If you happen to send a grievance by email, they are bound to acknowledge the same within three working days.
3. Approach the GRC of the Consumer Affairs Department of the IRDAI
If the health insurance company in question does not respond within a reasonable timeframe, or if you are not satisfied with the response, you may then approach the Grievance Redressal Cell of the IRDAI. For this you need to fill up the Complaint Registration Form of the GRC with all the details of the complaint. Be sure to include your policy identification number as well. You could send the complaint by email to complaints@irdai.gov.in.
If you are not comfortable with email or do not have regular access to a network, you could also submit your complaint in writing to the following:
General Manager
Insurance Regulatory and Development Authority of India(IRDAI)
Consumer Affairs Department – Grievance Redressal Cell.
Sy.No.115/1, Financial District, Nanakramguda,
Gachibowli, Hyderabad – 500 032
Thus, if you are not satisfied with the service provided by your health insurance provider, and are confident that you have sufficient grounds to complain, you should first approach the Grievance Redressal Cell of the company concerned. Hopefully, your complaint will be resolved. If not, you could place your complaint before the GRC of the IRDAI.
Read more -
