Pay attention before taking health insurance! Which companies reject people's claims the most? See the full report
Health Insurance Complaints: Be careful! These are the 5 worst health insurance companies in the country; they reject the most claims. Revealed in the 2023-24 report of the Insurance Ombudsman. See the full list.
Health Insurance Complaints: Imagine you bought a health insurance policy with great expectations. You are also paying its premium on time every year. But when a medical emergency comes and you have to be admitted to the hospital, your insurance company either rejects your claim completely or gives so little money that you have to pay most of the hospital bill from your own pocket.
If this has ever happened to you, then believe me you are not alone. Every year thousands of policyholders, troubled by this attitude of insurance companies, knock on the door of the Insurance Ombudsman. Now, the 2023-24 annual report of the Insurance Ombudsman Council (CIO) has come out, revealing the health insurance companies against which the most complaints have been filed.
Which companies have the most complaints?
According to the latest report of the Insurance Ombudsman, the company against which the most complaints were received during the financial year 2023-24 is Star Health & Allied Insurance Co. Ltd.
A total of 13,308 complaints were filed against Star Health. The shocking thing is that out of these, 10,196 complaints were only about partial or complete rejection of the claim.
CARE Health Insurance is at number two, against which 3,718 complaints were received.
Niva Bupa Health Insurance is at the third place, against which 2,511 complaints were filed.
There are also two government insurance companies in this list - National Insurance Co. National Insurance Co. Ltd (2,196 complaints) and The New India Assurance Co. Ltd. (1,602 complaints).
One thing that is clearly visible in this list is the sheer number of complaints against Star Health. Even if you add the complaints of the other four companies except Star Health, it still does not come close to the total complaints of Star Health.
It is not just about size, it is about service: complaints per lakh customers
Now, one can argue that a company with more customers will have more complaints. This is true to some extent. So, we analysed another important statistic - how many complaints were filed per 1 lakh customers. This gives an idea of the kind of service the company is providing to its customers. Star Health is at the top on this scale too.
Star Health: 63 complaints per 1 lakh customers.
Niva Bupa: 17 complaints per 1 lakh customers.
CARE Health: 16 complaints per 1 lakh customers.
This figure shows that despite the size of the customer base, Star Health customers are the most unhappy with their company and need to approach the Ombudsman.
Top 5 companies in terms of claim rejections
Star Health: 10,196 complaints
CARE Health: 2,393 complaints
Niva Bupa: 1,770 complaints
National Insurance: 1,419 complaints
Aditya Birla Health Insurance: 1,006 complaints
Which companies had to pay the highest compensation?
The advantage of complaining to the Ombudsman is that it can order the insurance company to pay compensation. The decision of the Ombudsman is binding on the insurance company. Companies ordered by the Ombudsman to pay the highest compensation:
Star Health: Compensation of ₹60.54 crore in 7,506 cases.
CARE Health: Compensation of ₹20.12 crore in 1,687 cases.
Niva Bupa: Compensation of ₹16.54 crore in 1,297 cases.
HDFC Ergo: Compensation of ₹6.48 crore in 565 cases.
National Insurance: Compensation of ₹5.40 crore in 1,015 cases.
Are complaints increasing in health insurance?
Yes, and this is a worrying trend. The CIO report shows that while complaints in life insurance and general insurance have decreased, complaints in health insurance have increased by a huge 21.7%. In this too, most of the complaints (26,064) are against private sector insurance companies, while this figure (5,298) against government companies is very low.
Will IRDAI's new move change anything?
Recently, insurance regulator IRDAI has directed to create an 'Internal Ombudsman' inside every insurance company. This internal ombudsman will look into complaints related to claims up to Rs 50 lakh, which the company has not resolved within 30 days. However, some experts are questioning the effectiveness of this move, because this internal ombudsman will report to the MD/CEO of the company itself, which may raise doubts about its impartiality.
Conclusion
This report of the Insurance Ombudsman is an eye-opener for everyone who is planning to buy health insurance or has already bought it. It clearly shows that do not just go by the big name or attractive advertisements, but also check the claim settlement record and number of complaints of any company before buying its policy. Remember, only an aware customer can protect his rights.
Frequently Asked Questions (FAQs)
Question 1: What is Insurance Ombudsman?
Answer: Insurance Ombudsman is an independent government body where you can lodge a complaint against your insurance company for free, if you are not satisfied with their decision.
Question 2: How can I complain to the Ombudsman?
Answer: You can visit the official website of Insurance Ombudsman and lodge a complaint online. This process is completely free and does not require any lawyer.
Question 3: According to this report, which company has the most complaints?
Answer: According to this report, Star Health and Allied Insurance has the most complaints both in terms of total complaints and complaints per lakh customers.
Question 4: What should I do if the claim is rejected?
Answer: First of all, contact the Grievance Redressal Officer of your insurance company. If you do not get a satisfactory response from there within 30 days, then you can lodge your complaint with the Insurance Ombudsman.
Question 5: Does the insurance company have to accept the decision of the Ombudsman?
Answer: Yes, if the Ombudsman gives an 'award' i.e. a decision to give compensation, then it is legally binding on the insurance company.
