A rejected insurance claim, a partial settlement or an unexplained delay in reimbursement can leave policyholders uncertain about where to seek relief. While insurers have internal grievance redressal mechanisms, policyholders can escalate unresolved disputes to the insurance regulator’s grievance portal and, in eligible cases, approach the Insurance Ombudsman.
Understanding the escalation process, applicable timelines and obligations of insurers can help consumers navigate insurance disputes more effectively.
Approach the insurer’s grievance redressal officer
The first step in an insurance dispute is to approach the insurer directly. Every insurer is required to have a Grievance Redressal Officer (GRO) to handle complaints relating to policy servicing, claim rejection, delays in settlement and other policy-related issues.
Policyholders should submit their complaints through the insurer’s official grievance channel and retain the complaint reference number, policy documents, claim papers, correspondence and other supporting records.
Under IRDAI’s policyholder protection framework, insurers are required to resolve grievances within 14 days of receiving them.
If the complaint is rejected, the response is unsatisfactory or the insurer does not resolve it within the prescribed period, the policyholder can explore further escalation.
Escalate the complaint through Bima Bharosa
Bima Bharosa is IRDAI’s integrated grievance management system through which policyholders can register complaints against insurance companies.
Consumers can use the portal to submit grievances, track their status and escalate unresolved matters to the regulator. The platform provides an additional channel for complaints involving claim settlement, policy issuance, premium-related issues and delays in service.
However, registering a complaint on Bima Bharosa does not automatically mean that the regulator will award compensation or decide every contractual dispute. The nature of the complaint and the available regulatory or dispute-resolution mechanism determine the next course of action.
Approach the Insurance Ombudsman
If a complaint remains unresolved, the Insurance Ombudsman provides an independent mechanism for resolving eligible disputes between policyholders and insurers.
A policyholder can approach the Ombudsman if:
- The insurer has rejected the complaint or the policyholder is dissatisfied with its response.
- The insurer has not responded within 30 days of receiving the complaint.
- The complaint falls within the Ombudsman’s jurisdiction and other eligibility conditions are met.
- The complaint should generally be filed within one year of receiving the insurer’s final response or the expiry of the 30-day response period, as applicable.
The Insurance Ombudsman handles specified disputes, including claim repudiation, partial or delayed claim settlement, policy servicing and other matters covered under the Insurance Ombudsman Rules.
The complaint must satisfy the applicable monetary and jurisdictional limits. The Ombudsman route is intended for eligible individual policyholder disputes and is not a substitute for every form of legal proceeding.
How long does an Ombudsman take to decide a complaint?
Under the Insurance Ombudsman Rules, 2017, the Ombudsman is required to pass an award within three months of receiving all requirements from the complainant.
However, the time taken before a case reaches the hearing stage can vary.
An analysis of 12,550 cases by Insurance Samadhan, based on records with valid Form 6A submission and hearing dates, found that the median interval between submission of Form 6A and the hearing was 27 days. The average was 71 days, while 20.3% of cases took more than 90 days. Among cases with hearings recorded in 2026, the median interval increased to 71 days, compared with 31 days in 2025 and 16 days in 2024.
These figures represent the company’s own case records and not nationwide Ombudsman data.
Shilpa Arora, Co-founder and COO of Insurance Samadhan, said policyholders can face difficulties tracking cases awaiting hearing dates.
“Policyholders are often dependent on repeated follow-ups with the concerned Ombudsman’s office. A time-bound escalation and status-tracking mechanism is needed so that consumers can know the status of their cases and the action being taken,” she said.
The distinction between the time taken to schedule a hearing and the prescribed period for passing an award is important when assessing the overall grievance redressal timeline.
What happens after the Ombudsman passes an award?
An award passed by the Insurance Ombudsman is binding on the insurer, subject to the applicable provisions for appeal.
The insurer is required to comply within 30 days of receiving the award and inform the Ombudsman about its implementation.
The regulatory framework also provides for a penalty of ₹5,000 per day for non-compliance, subject to applicable conditions, including the provisions relating to appeals.
For policyholders, it is important to retain a copy of the award and monitor whether the insurer has implemented the directions, including payment of the awarded amount wherever applicable.
Arora said there is a gap between the requirement for insurers to report compliance and the ability of policyholders to track whether the award has actually been implemented.
“While insurers are required to report compliance to the Ombudsman, policyholders do not have a clearly defined, dedicated mechanism on Bima Bharosa to report non-compliance and track the action taken,” she said.
A formal post-award escalation facility could allow policyholders to flag non-compliance, monitor progress and seek closure without repeatedly contacting the Ombudsman’s office.
Why repeated documentation requests can delay resolution
Documentation plays an important role in establishing the facts of an insurance dispute. However, repeated requests for documents already submitted can add to the time taken to resolve complaints.
Policyholders should maintain copies of the insurance policy, premium receipts, claim forms, medical records or other supporting documents, claim rejection or settlement communication, and all correspondence with the insurer and Ombudsman.
Maintaining a record of every submission can help policyholders respond to requests for additional information and flag instances where documents already provided are sought again.
According to Arora, Insurance Samadhan has encountered cases where documents already uploaded to the Ombudsman portal are requested again.
“A system that maintains document submission histories, clearly identifies outstanding requirements and allows consumers to flag duplicate requests could reduce procedural delays,” she said.
A centralised document-management mechanism could also ensure that information submitted at one stage is available to the relevant teams at subsequent stages.
Can long-pending insurance disputes be settled through mediation?
Some insurance disputes may be resolved through negotiated settlements or mediation, depending on the facts of the case and the willingness of both parties.
For disputes pending in courts, voluntary settlement discussions between insurers and policyholders may offer an alternative where a mutually acceptable resolution is possible.
However, consumers should assess any settlement offer carefully and should not feel pressured to accept an amount lower than their legitimate claim. Cases requiring judicial determination would continue through the courts.
The broader objective of grievance redressal is to ensure that policyholders have access to a transparent and time-bound process, from the initial complaint to the actual implementation of the relief granted.
NOTE TO READERS
Disclaimer: This article is for informational purposes only and should not be construed as investment advice. Readers should consult certified experts before making any investment decisions.