I bought my health insurance policy in 2016 for myself and my wife. I renewed the policy every year by paying timely premiums till last year. In December 2022, I suffered from typhoid and was admitted in hospital for seven days. The treatment cost me around ₹2 lakh. My insurer denied the claim saying that my condition did not require hospitalization. What can I do to get my claim from the insurance company?
-Name withheld on request
Since you are not satisfied with the response given by your insurer, you have multiple options to file a complaint.
You can directly register your grievance on the Insurance Regulatory and Development Authority of India’s (IRDAI) online portal, known as the ‘Bima Bharosa System’. You can choose to submit your complaint via email to complaints@irdai.gov.in, or you can avail of the toll-free helpline at 155255 or 1800 4254 732.
You can lodge a complaint to the Insurance Ombudsman within one year from the date of rejection by the insurance company.
Since the incident happened in December 2022, you still have time. You can file your complaint online on https://www.cioins.co.in or you can visit your nearest ombudsman office and file an offline complaint.
Alternatively, you can file a complaint with the consumer Court. Since, the amount of claim is only ₹2 lakh, you can file a complaint with the district consumer disputes redressal forum.
You can either file the complaint online or you can also write the complaint, attach all relevant documents and register it offline. You will also have to file an affidavit in the court stating that all the facts and statements presented by you are true and correct. The consumer forum may charge you a fee ranging from ₹100 to ₹5,000.
In a similar case, the Surat District Consumer Redressal Commission issued a directive to an insurance company last month. The commission ruled that the decision regarding the need for hospitalization should be entrusted to medical professionals’ discretion rather than being solely determined by the insurance company.
Nidhi Verma is founder and chief executive officer at Algates Insurance
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Updated: 18 Sep 2023, 10:32 PM IST