Claim related complaints in the insurance industry have increased over the last three years.
IRDAI data shows that while life insurance companies received 32,921 complaints related to claims, nonlife insurance companies recorded 32,800 claim complaints in the financial year 2019-20.
In percentage terms, 66% of complaints in non-life insurance were claim related last year. Of the total 50,000 complaints in general insurance, 32,880 claim were related to claims. Claim complaints were 26,480 in 2015-16, 27,637 in 2016-17, 25,401 in 2017-18 and 26,496 in 2018-19.
Similarly, life insurers received 32,921 claim related complaints out of a total 1.65 lakh complaints in 2019-20. Claim related complaints were 21,212 in 2017-18 and 27,786 in 2018-19.
Here are some key reasons for claim related complaints:
● Insurers not making claim payment
● Discrepancy in claims received and claims requested
● Insurers reduced the claim amount without justifying reasons
● Insurers rejected claims citing alleged breach of terms and conditions
● Claim rejection without giving reasons
IRDAI asked insurance companies to put in place systems and processes to deal with claim requests. The insurance regulator said, “Providing a reasoned and timely decision about the claim can help mitigate the agony of the claimant in approaching various channels only to understand why there is a delay and what is the reason for repudiation of claim in full or in part. A suitable mechanism at insurer’s level to ensure that this information is provided promptly would reduce the number of complaints relating to claims.”
