A Focus On Grievance And Complaint
Outlook Money|September 2020
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.

“It is a matter of perception. Some people are satisfied with the services provided by the private sector health insurers, whereas the few others are happy with the state-run general insurers for the same. It is the market share enjoyed by various insurers which can be seen as a differentiator,” says Sanjay Datta, Chief Underwriting and Claims, ICICI Lombard GI.

PED is another grey area where people face difficulties while buying a policy or even at the time of claim settlement.

Abhishek Muthiah, a start-up coach from Coimbatore, is suffering from bone-related diseases. Soon, after having a successful surgery in July 2018 he applied for a health insurance top-up plan as his existing base plan did not have the necessary coverage to compensate for the COVID-19 treatment.

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September 2020