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Top five common insurance complaints in India and how to resolve them

From delays in claim settlement to unfair terms and poor customer service, policyholders face a number of issues with their insurance service providers.

July 25, 2023 / 10:48 AM IST
Health insurance complaints

How to resolve health insurance grievances

Insurance is a significant component of financial planning and protection in India. But for many, their journey with insurance companies has not been as smooth. There are innumerable instances where policyholders have run into problems with their insurance companies.

Let us look at the top five common insurance complaints in India and provide guidance on how to effectively resolve them. By understanding these hurdles and taking the appropriate precautions and measures, policyholders can ensure a smoother and more positive insurance experience.

Also Read | Why policyholders are unhappy with insurance companies

Delays in the timeframe of settlement of claims

One of the most frequent grievances faced by policyholders is the lengthy delay in the settlement of claims. At times, claims processing and settlement might take a long time, causing significant inconvenience and financial stress for policyholders.

To address this issue, policyholders should maintain appropriate documentation. Keeping comprehensive records of policy information, claim forms, medical reports, bills, and any other relevant documents can help accelerate the claim settlement process.

Besides, policyholders should quickly submit all required documents to the insurance company and follow up frequently to ensure the progress of their claims. If delays persist, taking the complaint to higher authorities within the insurance company can be effective in expediting the resolution.

Insufficient coverage

Another typical complaint is insufficient coverage. Policyholders may find themselves in a situation where their insurance policy does not provide the expected financial protection during a claim event. This could be owing to indistinct policy terms, exclusions, or limitations that were not properly communicated or understood.

To avoid being in this situation, policyholders should systematically review their insurance policies before purchase. It is vital to read the policy terms and conditions prudently and seek clarification from the insurance company or agent if any uncertainties arise.

In case of discontentment with the coverage, policyholders can look at the possibility of modifying their policy or switching to a different insurance provider that provides all-inclusive coverage.

Unfair policy terms

Unfair policy terms are also a significant source of complaints in the insurance sector. Policyholders often end up with certain clauses or conditions that were not effectively revealed or explained during the policy purchase process. This can subsequently lead to misunderstandings and disputes at the time of filing a claim.

To tackle this issue, policyholders should be cautious in comprehending all aspects of the policy. Reading the policy document carefully, including the fine print, is essential to identify any unfair or ambiguous terms. If discrepancies are found, policyholders should approach the insurance company for clarification and request a written response addressing their concerns. If the issue remains unresolved, seeking legal advice or filing a complaint with the insurance regulatory authorities can be considered.

Also Read | A mistake in filling up the hospital forms can cost you your insurance claims

Poor customer service

Poor customer service is a problem across all industries, and insurance too is no exception. Policyholders typically face difficulties in reaching out to their insurance providers and often the processes and formalities take a toll on them.

To overcome this issue, policyholders should uphold a record of all communication with the insurance company, including dates, names of representatives spoken to, and the content of conversations or emails. When facing poor customer service, escalating the complaint to higher authorities within the company can often lead to a more prompt and satisfactory resolution. Policyholders may also consider exploring alternative communication channels, such as online portals or social media platforms, to reach out to the insurance company and seek a resolution.

Non-disclosure of critical information 

A lot of claims get rejected due to non-disclosure of material facts. Providing all the information asked for is essential as the same is essential for insurance underwriting. Filling up the proposal forms might seem a lengthy process but the same is very vital.

The insured should ensure that all the required information is shared with the insurer and there is no hiding of facts relating to pre-existing diseases, health issues, hospitalisations etc.

While insurance complaints are not uncommon in India, policyholders have the option to take effective measures to overcome these issues efficiently. With systematic handling such as maintaining proper documentation, following up with the insurance company, complaining to higher authorities when needed, and turning to timely assistance, policyholders can boost their chances of attaining a satisfactory resolution.

Shilpa Arora is the Co-Founder and Chief Operating Officer of Insurance Samadhan
first published: Jul 25, 2023 10:48 am

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