How to File a Complaint against an Insurance Company?

Claim rejection or poor service from an insurance company can cause a lot of frustration. Filing a complaint against an insurance company can be a crucial step when faced with unresolved issues or denied claims. Understanding the proper procedure ensures your concerns are addressed effectively through the right channels. This process activates legal protections that ensure fair treatment. The Insurance Regulatory and Development Authority of India (IRDAI) and consumer laws provide strong safeguards. These rules help resolve disputes and make sure your concerns are formally heard and addressed. In this blog, you will learn how to file a complaint against an Insurance company. Read to know more.

Who Can File a Complaint?

According to the Insurance Regulatory and Development Authority of India (IRDAI), any individual acting as a proposer or policyholder can file a complaint against an insurance company. This includes:

Policyholders

A policyholder is a person who holds an active insurance policy with an insurance company. This individual has entered into a contract with the insurer and pays premiums regularly. The policyholder can raise complaints related to claim settlement delays, denial of claims, premium issues, policy servicing, or any other dissatisfaction with the insurer’s services.

Proposers

A proposer is a person who applies for an insurance policy but has not yet received the policy document. If the insurance company delays policy issuance, rejects the application unfairly, or does not provide the required information, the proposer can file a complaint to address these issues.

Legal Heirs

When the policyholder passes away, the legal heirs gain the right to manage the policy benefits. They can file complaints on behalf of the deceased policyholder, particularly in cases involving claim settlements or any dispute related to the policy proceeds. Legal heirs must provide proof of their relationship with the policyholder to the insurance company or grievance authorities.

Nominees or Assignees

Nominees are individuals designated to receive insurance benefits when the policyholder dies. Similarly, assignees receive rights to the policy benefits through an assignment process. Both nominees and assignees have the right to file complaints if they face issues in claiming the insurance proceeds or if the insurance company denies or delays payments.

Each of these parties can access the insurer’s grievance redressal system first. If the issue remains unresolved, they can escalate complaints to regulatory bodies such as IRDAI or the Insurance Ombudsman for further resolution. This ensures a proper mechanism to protect the rights of all stakeholders connected to the insurance policy.

When to File a Complaint?

If problems arise with an insurance company, such as delays in claim processing, incorrect policy information, or poor service, filing a complaint is the right step. The Insurance Regulatory and Development Authority of India (IRDAI) advises policyholders to first contact the insurer’s Grievance Redressal Officer. If the complaint is not resolved within 15 days, it can be escalated to IRDAI via the Bima Bharosa portal, email, or toll-free numbers. If the issue remains unresolved and the claim amount is under Rs. 30 lakh, policyholders may approach the Insurance Ombudsman, especially when the insurer fails to respond within 30 days.

Reasons to File a Complaint against an Insurance Company

Here is the key reason to file a complaint against an Insurance Company:

Non-settlement or Delayed Settlement of Claims

When an insurance company refuses or delays paying a valid claim without a reasonable cause, it causes financial loss and distress to the policyholder. The insurer must settle claims within the time period specified in the policy or as per regulatory guidelines. If the company fails to do so, policyholders should file a complaint to seek timely resolution and compensation for any losses caused due to the delay.

Misrepresentation or Mis-selling of Policies

Sometimes, insurance agents provide incorrect or incomplete information about the policy terms, coverage, or benefits. This misleads the customer and may result in purchasing an unsuitable product. If a policyholder faces loss due to such misrepresentation, filing a complaint helps protect consumer rights and holds the insurer accountable for unfair sales practices.

Unilateral Alteration of Policy Terms

Insurance companies cannot change the terms and conditions of a policy without the policyholder’s approval. Any change in coverage, premiums, or benefits requires the customer’s consent at the time of renewal or before. If an insurer imposes changes unilaterally, policyholders can challenge this action by filing a formal complaint.

Non-Issuance of Policy After Premium Payment

When a customer pays the premium but does not receive the insurance policy document, it amounts to a breach of contract. The insurer has an obligation to provide the policy within a reasonable time after payment. Failure to issue the policy leaves the customer unprotected and necessitates filing a complaint for redressal.

Deficiency in Service or Poor Customer Support

Insurance companies must provide proper assistance and respond promptly to customer queries or grievances. If the insurer shows negligence, delays responses, or provides incorrect information, it reflects poor service quality. Filing a complaint can urge the company to improve its customer care standards and resolve issues efficiently.

Unjustified Policy Cancellations

A policyholder’s insurance policy cannot be cancelled arbitrarily without a valid reason or prior notice. The insurer must follow legal guidelines and inform the customer well in advance before cancellation. If a policy gets cancelled unfairly, the policyholder should file a complaint to restore coverage or seek compensation.

Unfair Claim Denials

Insurance companies must provide clear and valid reasons when they deny claims. If a claim denial lacks proper justification or is based on vague grounds, the customer has the right to question it. Filing a complaint can initiate a review of the claim and push the insurer to make fair decisions.

Non-Compliance with Regulatory Guidelines

Insurers must follow all rules and procedures issued by the Insurance Regulatory and Development Authority of India (IRDAI), including timelines for complaint resolution. When an insurer violates these regulations or fails to resolve grievances within stipulated periods, customers should report such lapses through formal complaints.

Disputes Over Premium Amounts or Policy Terms

Sometimes, disagreements arise between the insurer and policyholder regarding premium rates, renewal charges, or specific policy clauses. Such disputes require clarification and resolution to prevent financial loss or confusion. Filing a complaint helps bring the issue to the attention of the regulatory authority for fair judgment.

Lack of Transparency in Policy Documents

Insurance policies must clearly state all terms, conditions, benefits, exclusions, and charges. If the documentation is ambiguous, incomplete, or difficult to understand, customers may unknowingly face problems later. Filing a complaint urges insurers to improve transparency and provide clearer policy details.

How to File a Complaint against an Insurance Company?

Here is a step-by-step process to file a complaint against an Insurance company:

Step 1: Approach the Insurance Company First

Start your complaint process with the insurance company itself. Locate the Grievance Redressal Officer (GRO) either at a branch office or through the insurer’s website. Submit your complaint in writing or via email, clearly stating the issue and the resolution you expect. Request an acknowledgment that confirms receipt of your complaint along with the date. Keep all communication records carefully. This step allows the insurer to resolve the matter internally before it escalates further.

Step 2: Escalate the Complaint to IRDAI

If the insurer does not respond within the stipulated time or if you are not satisfied with their reply, escalate your complaint to the Insurance Regulatory and Development Authority of India (IRDAI). You can submit the complaint online on the Bima Bharosa portal or send it through email. IRDAI also offers toll-free helpline numbers for assistance. Make sure to include all details and documents related to your complaint. The authority intervenes to ensure fair treatment and resolution of your grievance.

Step 3: Approach the Insurance Ombudsman

If the complaint remains unresolved after contacting IRDAI, approach the Insurance Ombudsman. The Ombudsman acts as a neutral mediator and provides a free, simplified process to settle disputes. This option applies only if the claim value falls within a prescribed limit and the insurer fails to address the issue satisfactorily. Submit a formal complaint to the Ombudsman office within whose jurisdiction your complaint falls. The Ombudsman reviews the case and provides a binding decision that helps both parties. If you prefer a faster, more convenient, and cost-effective way to settle your dispute, you can also file your insurance complaint through Online Dispute Resolution (ODR). ODR allows you to resolve your issue digitally through mediation and arbitration, without visiting any physical office or court.

What is Online Dispute Resolution?

Online Dispute Resolution is an entirely digital system for resolving disputes, utilising technology-driven platforms to facilitate every stage from the initial filing and evidence submission to virtual hearings, negotiations, and final decisions. It incorporates traditional dispute resolution methods such as negotiation, mediation, and arbitration, all conducted online via tools like video conferencing, chat, and secure document sharing. This comprehensive online workflow enables parties to engage in dispute resolution without needing to meet in person, making the process more convenient and accessible while maintaining the structured framework of Alternative Dispute Resolution methods.

Why Choose Online Dispute Resolution?

Consumers prefer ODR for several reasons:

Cost-effective & Time-efficient

Online Dispute Resolution (ODR) significantly cuts down on expenses related to travel, legal representation, and court fees. Since the entire process takes place digitally, parties can save both time and money that would otherwise be spent attending physical hearings or waiting through lengthy legal procedures. Most disputes are resolved in a matter of days or weeks instead of the months—or even years—it often takes in traditional courts.

Accessible & Convenient

ODR platforms are designed to be user-friendly and available around the clock, allowing participants to engage in the process from anywhere in the world. This makes it especially beneficial for cross-border or interstate disputes where physical presence can be challenging. Whether you’re a consumer or a business, you can submit evidence, communicate with the other party, and attend virtual hearings—all from the comfort of your home or office.

Privacy & Security

Unlike traditional court proceedings that are often public, ODR ensures a higher degree of confidentiality. Sensitive documents, communications, and decisions are securely handled through encrypted digital platforms. This protects the privacy of both parties and provides a safe, confidential environment for resolving disputes without public exposure.

How to File a Complaint through ODR?

Filing a complaint through Online Dispute Resolution (ODR) is a convenient and structured way to resolve disputes without going to court. The process is entirely digital from submitting your complaint to reaching a settlement and involves mediation and arbitration facilitated by a neutral third party.

Here’s a step-by-step guide to filing a complaint through ODR:

Step 1: Collect All Relevant Evidence

Before initiating your complaint, gather all documents and proofs that support your claim. These may include:

• Receipts or invoices
• Emails, chat transcripts, or messages with the company
• Photographs or videos of defective products or damages
• Payment proofs, bank statements, or transaction records

Having clear and well-organized evidence strengthens your case and helps the mediator or arbitrator assess your claim quickly.

Step 2: Submit Your Dispute Through an ODR Platform

Once you have all the evidence, visit an official Government ODR Portal or a private ODR platform such as Online Legal India.
Here’s what to do:

1. Fill in your details and describe your issue clearly.
2. Attach all supporting documents and evidence.
3. Submit your complaint for review.

After submission, the platform will appoint a neutral mediator. The appointed professional will send a notice of mediation to the other party.

Step 3: Participate in Mediation Proceedings

In most cases, ODR begins with mediation a voluntary and non-binding process aimed at mutual settlement.
During the mediation:

• The mediator facilitates discussions between you and the other party via email, chat, or video conferencing.
• Both parties share their perspectives and work toward a mutually agreeable resolution.

After the mediation process:

• The mediator prepares a Mediation Report summarizing the discussion and recommendations.
• If both parties agree, a settlement agreement is drafted and signed digitally.

Possible mediation outcomes may include:

• Refund or replacement of products
• Compensation for damages or inconvenience
• Official apology or service correction
• Any other mutually agreed resolution

Step 4: Arbitration

If there is any existing arbitration clause in the contract regarding a residential society, then the case will be handled through an arbitrator. During the arbitration process, a neutral arbitrator (or a panel of arbitrators) reviews the dispute and hears both sides through virtual hearings. Then, they issue a binding decision, which is known as an arbitral award. This final decision is regulated under the Arbitration and Conciliation Act, 1996. Both parties must agree and follow the final decision. If any party refuses to follow the arbitral award, the other party can approach the appropriate court. The court can then enforce the decision under the Arbitration and Conciliation Act, 1996.

Conclusion

Filing a complaint against an insurance company plays a vital role in protecting policyholders’ rights and ensuring fair treatment. Following the correct procedure from initially contacting the insurer to escalating the matter to IRDAI, the Insurance Ombudsman, or the ODR helps resolve disputes effectively. Patience and persistence remain essential throughout the process. Understanding available options and using proper channels enables policyholders to achieve fair resolutions and safeguard their financial interests. If you require any assistance in filling your complaint through ODR, get in touch with Online Legal India.