Listen to this article
The whole article read aloud, about 12 minutes
The audio could not be played here. Open this page in Chrome or Safari and try again.
If your insurer rejects your claim, pays only part of it, or simply does not reply to your complaint, you have a free way to fight back. You complain to the insurer first. If that does not work, you can go to IRDAI through its Bima Bharosa portal, and after that to the Insurance Ombudsman. Here is what each step involves and when to take it.
What kind of problems is this for?
The same route works for life, health, motor, home or any other policy. Typical problems include:
- A claim rejected fully, or only partly paid
- Delay in paying a claim
- No policy issued even after you paid the premium, or a policy that does not match the proposal form you filled
- Poor service from the insurer, an agent, a broker or a TPA (the third-party administrator that handles health claims for many insurers)
Step 1: Complain to the insurer first
Under IRDAI’s rules, your first complaint goes to the insurance company. You can use any of these:
- Visit the insurer’s nearest branch
- Send a letter or an email
- Use the grievance section on the insurer’s website
- Call the insurer’s call centre
You can also register the complaint directly on IRDAI’s Bima Bharosa portal (bimabharosa.irdai.gov.in). Insurers’ grievance systems are linked to this portal, so the complaint still reaches the insurer.
How fast must the insurer act? According to IRDAI’s Master Circular on Protection of Policyholders’ Interests (5 September 2024):
- You must get an acknowledgement as soon as the complaint is received
- The insurer should resolve it within 14 days
- If the insurer does not accept your complaint, it must give reasons that point to the specific policy terms it is relying on
You can track the complaint on Bima Bharosa, on the insurer’s grievance portal or through its call centre. Keep the complaint number and every reply safe. You will need them for the next steps.
Step 2: Not happy with the reply? Go to IRDAI
The IRDAI policyholder portal says you can approach IRDAI’s grievance cell if the insurer does not reply in reasonable time or if you are not satisfied with its reply. Ways to reach IRDAI:
| Channel | Details |
|---|---|
| Online | bimabharosa.irdai.gov.in (register and track complaints) |
| Toll-free | 155255 or 1800 4254 732 |
| complaints@irdai.gov.in | |
| Post | General Manager, IRDAI, Policyholder’s Protection & Grievance Redressal Department, Grievance Redressal Cell, Sy.No.115/1, Financial District, Nanakramguda, Gachibowli, Hyderabad – 500 032 |
Even a complaint filed on Bima Bharosa is resolved by the insurer itself; the portal lets you track it. The body that can pass an award binding the insurer to pay is the Ombudsman, in the next step.
Two things to note. IRDAI accepts complaints only from the policyholder or the claimant; complaints filed by advocates, agents or other third parties on your behalf are not taken up. And the Bima Bharosa portal never asks for money. If someone sends you a QR code or a link saying it will “release your claim money”, it is a fraud.
Step 3: The Insurance Ombudsman — free and without a lawyer
The Insurance Ombudsman is a government-created forum that settles disputes between policyholders and insurers, under the Insurance Ombudsman Rules, 2017. There is no fee, and you do not need a lawyer. It covers policies taken in an individual capacity, group policies (such as an employer’s group health cover), and policies of sole proprietorships and micro enterprises. Large corporate business policies are outside it.
When can you go? You must first have complained to the insurer in writing (letter, email or online), and then one of these must have happened:
- The insurer rejected your complaint
- You are not satisfied with the insurer’s reply
- You got no reply within one month of the insurer receiving your complaint
| Rule | What it means |
|---|---|
| Time limit | File within one year of receiving the insurer’s rejection or reply. If there was no reply: within one year after one month has passed from the date you sent your complaint. The Ombudsman can condone a delay if there is good reason |
| Claim amount | Up to ₹50 lakh (as per the IRDAI Master Circular 2024 and the CIO website) |
| Fee | None |
| How to file | Online at cioins.co.in/Complaint/Online; by letter or email; or in person at the office |
| Decision time | If both sides agree to mediation, a recommendation within one month. Otherwise an award (decision) within 3 months of receiving all required documents from you |
| Must the insurer follow it? | Yes. The award is binding on the insurer, which must comply within 30 days of receiving it. If it does not, it has to pay you a penalty of ₹5,000 for every day of delay (this penalty does not apply if the insurer appeals within 30 days, in which case it must inform you) |
| Condition | The Ombudsman will not take up a matter that is pending before, or already decided by, a court, consumer forum or arbitrator |
Which office for Andhra Pradesh and Telangana? There are 17 Ombudsman offices in India. Andhra Pradesh, Telangana and Yanam are covered by the Hyderabad office:
- Address: 6-2-46, 1st floor, “Moin Court”, Lane Opp. Hyundai Showroom, A. C. Guards, Lakdi-Ka-Pool, Hyderabad – 500 004
- Phone: 040-23312122 / 23376991 / 23376599 / 23328709 / 23325325
- Email: oio.hyderabad@cioins.co.in
Under the rules, you can file with the office that covers either where you live or where the insurer’s branch is. IRDAI also requires the Ombudsman’s details to be printed in your policy document and in the insurer’s reply letter. Contact details can change, so check the CIO website before you go.
Documents the Ombudsman asks for (as per the CIO FAQ): a copy of your complaint to the insurer, the insurer’s rejection letter (if any), a copy of the policy, a KYC document (such as a driving licence), a photograph for online registration, and any other relevant papers.
What if you disagree with the Ombudsman?
The award binds the insurer, not you. The CIO FAQ says a policyholder who is not satisfied can still take the normal legal route against the insurer, such as a consumer commission or a court. At that stage it is sensible to take a lawyer’s advice.
A worked example
Ravi (42) lives in Guntur. His father’s hospital bill came to ₹1,80,000. The insurer paid only ₹60,000 on the health claim and gave no clear reason for cutting ₹1,20,000. (This is an imaginary example to explain the steps; dates and amounts are only illustrative.)
| Date | What Ravi did | What the rule says |
|---|---|---|
| 2 March | Filed a complaint on the insurer’s website and saved the reference number | Acknowledgement immediately; resolution within 14 days |
| 16 March | Insurer replied “deducted as per policy” without naming the clause | If the insurer does not accept a complaint, it must cite the specific policy terms |
| 18 March | Complained to IRDAI on Bima Bharosa | Allowed when not satisfied with the insurer’s reply |
| April (still unresolved) | Filed online with the Hyderabad Ombudsman, no fee | Within one year of the insurer’s reply (16 March); claim below ₹50 lakh |
| Within 3 months of giving all documents | Ombudsman passes an award | If the award is in Ravi’s favour, the insurer must pay within 30 days, or pay ₹5,000 a day for the delay |
Key terms
| Term | Simple meaning |
|---|---|
| Grievance | A complaint |
| GRO (Grievance Redressal Officer) | The officer at an insurer who handles complaints. Every insurer’s GRO details are on the IRDAI policyholder portal |
| Bima Bharosa | IRDAI’s complaint portal for registering and tracking complaints |
| Insurance Ombudsman | A free forum that settles disputes between policyholders and insurers |
| CIO (Council for Insurance Ombudsmen) | The body that runs the Ombudsman offices; website cioins.co.in |
| Award | The Ombudsman’s written decision |
Common myths and facts
| Myth | Fact |
|---|---|
| “Once the insurer says no, nothing can be done” | Not true. You can go to IRDAI and then to the Ombudsman |
| “The Ombudsman needs a lawyer and a fee” | No fee, and you can file yourself — online, by letter or in person |
| “I can go straight to the Ombudsman” | No. You must first complain to the insurer in writing |
| “There is no deadline” | There is normally a one-year limit for the Ombudsman. Don’t wait |
What to check before you complain
- What reason and which policy clause does the rejection letter mention? Read that clause in your policy document.
- Did you complain to the insurer in writing (email, online or letter)? A phone call alone may not count as proof at the Ombudsman stage.
- Have you saved the complaint number, dates and every reply?
- Have 14 days passed, or is the reply unsatisfactory? Then go to Bima Bharosa / IRDAI.
- How long ago did the insurer reply? Keep the one-year Ombudsman limit in mind.
- Is your claim below ₹50 lakh, and is there no court case on the same matter?
- Ignore anyone who says “pay a fee and we will get your claim”. Both IRDAI and the Ombudsman are free.
Sources
- IRDAI — Master Circular on Protection of Policyholders’ Interests, 2024 (Ref: IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 September 2024): 14-day resolution, Ombudsman up to ₹50 lakh, no fee, award compliance in 30 days, ₹5,000 a day penalty (Section VI)
- Insurance Ombudsman Rules, 2017 (copy published by the Council for Insurance Ombudsmen): Rule 14 (when and how to complain, one-year limit), Rules 16–17 (mediation, award within 3 months, binding on insurer), Rule 2 (which policies are covered). Note: this copy includes amendments up to 02-03-2021 and still shows a ₹30 lakh compensation cap; the current limit of ₹50 lakh is stated in the IRDAI Master Circular (2024) and on the CIO website.
- Council for Insurance Ombudsmen — FAQ: no fee, documents, options if not satisfied
- CIO — Offices of the Ombudsman: Hyderabad office address, phone and jurisdiction
- IRDAI policyholder portal — Grievance Redressal: IRDAI toll-free numbers, email and postal address
- IRDAI Bima Bharosa portal
All sources above were checked on 22 October 2026. Last updated: 22 October 2026.