How to complain to IRDAI about your health insurer
IRDAI (Insurance Regulatory and Development Authority of India) regulates all insurance companies. When your insurer doesn't resolve your complaint, IRDAI is your next escalation point — and you have multiple channels to use.
Step 1: Exhaust your insurer's grievance process first
Before IRDAI will consider your complaint, you must show that you tried to resolve it with your insurer directly. Send a written complaint to your insurer's Grievance Redressal Officer (GRO). The contact details should be in your policy document and on the insurer's website. By law, the insurer must acknowledge your complaint within 3 working days and resolve it within 15 working days. Keep a copy of everything: complaint email, acknowledgement, and any response.
Step 2: Use IRDAI's Bima Bharosa portal
If the insurer doesn't resolve your complaint within 30 days, you can file with IRDAI via: Website: bimabharosa.irdai.gov.in Toll-free: 155255 or 1800 4254 732 Email: complaints@irdai.gov.in What to provide: - Your policy number and insurer name - A clear description of the complaint - Reference number of your complaint with the insurer - Copies of the rejection letter and your complaint to the GRO IRDAI forwards the complaint to the insurer and monitors the resolution. This isn't a judicial process — IRDAI doesn't award compensation, but insurer compliance with IRDAI is mandatory.
Step 3: File with the Insurance Ombudsman (for compensation)
If you want the rejection reversed or compensation awarded, the Insurance Ombudsman is the right forum. Unlike IRDAI's grievance portal, the Ombudsman can award up to ₹30 lakhs and its decisions are binding on the insurer. Eligibility: - The dispute must be about a health insurance claim - Claim amount ≤ ₹50 lakhs - You must have filed with the insurer first - The rejection must be within the last 3 years File online at: cioins.co.in
Step 4: Consumer Forum (for larger claims or systemic issues)
If the claim amount exceeds the Ombudsman's jurisdiction, or if you want to pursue punitive damages, you can file at: District Consumer Disputes Redressal Commission: Claims up to ₹50 lakhs State Consumer Disputes Redressal Commission: Claims up to ₹2 crore National Consumer Disputes Redressal Commission: Claims above ₹2 crore Consumer forums can award compensation, litigation costs, and interest on delayed payments. The process is slower (12–24 months) but the awards can be much larger.
What IRDAI can and cannot do
IRDAI CAN: - Direct the insurer to settle your claim - Penalise the insurer for violating regulations - Require the insurer to improve internal processes - Initiate investigation into systemic claim rejection patterns IRDAI CANNOT: - Award you compensation directly - Legally compel specific payment to you (that's the Ombudsman's / court's job) - Act as a claims adjudicator Use IRDAI for regulatory violations and systemic issues. Use the Ombudsman for getting your specific claim paid.
Key timelines to know
- • Insurer acknowledgement: 3 working days
- • Insurer resolution: 15 working days
- • Escalate to IRDAI/Ombudsman after: 30 days without satisfactory resolution
- • Ombudsman time limit: 3 years from rejection date
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