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.

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:

1. 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.

2. 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.

3. 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.

4. 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:

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. Unjustified Policy Cancellations

A policyholder’s insurance policy cannot be canceled 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 canceled unfairly, the policyholder should file a complaint to restore coverage or seek compensation.

7. 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.

8. 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.

9. 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.

10. 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.

Step 4: Seek Legal Recourse if Necessary

If all other remedies fail, consider filing a complaint in Consumer Court or Civil Court. Consumer Courts offer a fast and affordable method to seek justice for insurance-related disputes. Prepare all necessary documents, including your policy papers, correspondence, and previous complaint responses. The court examines your case impartially and passes judgment based on the evidence presented. Legal action should be the last resort when all other avenues have been exhausted.

Filing a Complaint through Online Dispute Resolution (ODR)

Online Dispute Resolution (ODR) is a digital process that helps resolve issues like delayed or rejected insurance claims through tools such as mediation, conciliation, or arbitration. It works completely online using video calls, chats, and digital documents, removing the need to visit any office or court. Legally supported by Indian laws like the Arbitration Act, IT Act, and Consumer Protection Act, ODR offers a faster and more convenient way to settle disputes.

Here are the procedures to file Insurance Complaints through ODR:

Step 1: Check the Insurer’s Technology-Based Grievance System

Every insurance company must provide a digital grievance redressal system as per IRDAI regulations. This includes channels such as email support, video-enabled mobile applications, grievance submission forms on websites, and chatbot services. A policyholder should first raise the complaint through the official modes provided by the insurer. If the company responds within the allowed time frame and resolves the issue, no further action is needed. If it fails to act or the resolution is not satisfactory, the complaint moves to the next level.

Step 2:  Use the IRDAI “Bima Bharosa” Portal

If the insurer does not resolve the complaint within 15 to 30 days, the policyholder can escalate the issue through the IRDAI Bima Bharosa portal. This platform is the updated version of the IRDAI Grievance Management System (IGMS).

To file a complaint:

• Visit the official “Bima Bharosa” Portal
• Create an account or log in with existing credentials
• Enter policy details, attach supporting documents, and submit the complaint

The IRDAI forwards the complaint to the insurer, monitors the progress, and provides regular updates on the portal for the policyholder to track. This step ensures that the insurer remains accountable.

Step 3: Mediation and Arbitration through the ODR Process

If the complaint remains unresolved after escalation, it proceeds through the Online Dispute Resolution mechanism. This process happens in two stages:

• Online Conciliation or Mediation: A trained, neutral mediator communicates with both parties through a secure digital platform. The mediator reviews evidence, hears both sides, and attempts to settle the dispute within approximately 21 days. The communication happens through video calls, emails, or portal messages.
• Electronic Arbitration: If the dispute is not resolved through mediation or if it involves legal or technical complexity, it moves to arbitration. An arbitrator is appointed within about 5 working days. After reviewing the case, the arbitrator issues a final and binding decision. This decision carries legal weight under the Arbitration and Conciliation Act, 1996.

ODR in insurance is still evolving, but its structure follows proven models like those developed by SEBI and national ODR guidelines. IRDAI continues to improve digital timelines and resolution methods in line with national standards.

Step 4: Comply with the Arbitration Award

Once the arbitrator delivers the award, the insurer must take action within a specific period, usually 30 days. The insurer must comply with the award in full. If the insurer does not implement the award, the complainant can escalate the matter to either the Insurance Ombudsman or a legal forum such as the consumer court for enforcement.

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 courts 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 want to file a complaint against an Insurance Company, contact Online Legal India. They offers Consumer Dispute Resolution (CDR) through Online Dispute Resolution (ODR) services at the most affordable fees.