How do I file a grievance towards rejection of insurance coverage declare?

I purchased my medical insurance coverage in 2016 for myself and my spouse. I renewed the coverage yearly by paying well timed premiums until final 12 months. In December 2022, I suffered from typhoid and was admitted in hospital for seven days. The remedy value me round ₹2 lakh. My insurer denied the declare saying that my situation didn’t require hospitalization. What can I do to get my declare from the insurance coverage firm?

-Name withheld on request

Since you aren’t glad with the response given by your insurer, you’ve a number of choices to file a grievance.

You can straight register your grievance on the Insurance Regulatory and Development Authority of India’s (IRDAI) on-line portal, generally known as the ‘Bima Bharosa System’. You can select to submit your grievance by way of e-mail to complaints@irdai.gov.in, or you may avail of the toll-free helpline at 155255 or 1800 4254 732.

You can lodge a grievance to the Insurance Ombudsman inside one 12 months from the date of rejection by the insurance coverage firm.

Since the incident occurred in December 2022, you continue to have time. You can file your grievance on-line on https://www.cioins.co.in or you may go to your nearest ombudsman workplace and file an offline grievance.

Alternatively, you may file a grievance with the patron Court. Since, the quantity of declare is simply ₹2 lakh, you may file a grievance with the district client disputes redressal discussion board.

You can both file the grievance on-line or it’s also possible to write the grievance, connect all related paperwork and register it offline. You may also need to file an affidavit within the courtroom stating that each one the information and statements introduced by you’re true and proper. The client discussion board might cost you a charge starting from ₹100 to ₹5,000.

In an analogous case, the Surat District Consumer Redressal Commission issued a directive to an insurance coverage firm final month. The fee dominated that the choice relating to the necessity for hospitalization needs to be entrusted to medical professionals’ discretion relatively than being solely decided by the insurance coverage firm.

Nidhi Verma is founder and chief govt officer at Algates Insurance

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Updated: 18 Sep 2023, 10:32 PM IST

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