A Focus On Grievance And Complaint

Health insurance policyholders are caught between hard rock and deep-sea as they struggle to settle their claims

- Kumud Das

Holders of health insurance policies encounter multiple challenges when it comes to renewing old policies or getting their claims settled by insurance companies.

According to them, the insurers are busy patting their backs by claiming that they receive very few complaints from policyholders, hence suggesting that customers are largely satisfied with their services.

The government has appointed several Insurance Ombudsman across the country to handle grievances of insurance customers. Even though the move has brought the redressal framework into focus, it works through a system that appears to be quite discouraging.

Policyholders of Health Insurance (HI) are compelled to run from pillar to post to either get their policy renewed or even their claims settled.

Normally, they directly approach the ombudsman with their grievances. However, insurers often deny the renewal of HI policy on the ground of Pre-Existing Disease (PED). Their woes do not stop here, as it is found that the policyholders’ claims get deferred for an uncertain period on some flimsy ground.

Jagriti Chandra, a New Delhi based professional, had taken a health insurance policy from Oriental Insurance along with a top-up of ₹20 lakh from Liberty two years back.

“It has been two months that I despatched the claim form along with all the required originals and have not received an acknowledgment yet,” claims Chandra.

Now the question arises which insurer state-run or private sector one is better in terms of premium rates or hassle-free claim settlement.