IRDAI's Integrated Grievance Management System (IGMS) processed over 4.82 lakh health insurance grievances in FY2024-25, a 19 per cent increase from 4.05 lakh in FY24. This growth outpaced the 14 per cent increase in health insurance policies issued during the same period, meaning the complaint rate per policy is actually rising. The regulator's annual grievance data provides a window into which insurers are serving policyholders well and which are falling short.
Absolute Complaint Volumes
In absolute terms, the five insurers with the highest grievance volumes in FY25 were: Star Health (62,400 grievances), New India Assurance (58,100), ICICI Lombard (44,800), Bajaj Allianz (41,200), and National Insurance Company (38,600). However, absolute numbers are misleading because they correlate with policyholder base size. Star Health covers over 1.8 crore lives, so 62,400 grievances represents a different severity than National Insurance's 38,600 against a much smaller individual health portfolio.
Grievance Rate Per 10,000 Policies
The normalised metric that matters is grievances per 10,000 policies. On this basis, the five worst performers among health insurers in FY25 were: National Insurance Company (204 per 10,000), Oriental Insurance (188 per 10,000), United India Insurance (176 per 10,000), Bajaj Allianz (168 per 10,000), and Reliance General (156 per 10,000). The pattern is clear: public-sector general insurers dominate the worst-performers list, occupying three of the five positions. Their legacy systems, understaffing in claims departments, and slower digitisation contribute to higher complaint rates.
The industry average grievance rate was 118 per 10,000 policies. Among standalone health insurers, the average was lower at 98 per 10,000, reflecting their focused operational model.
What People Complain About
IRDAI categorises grievances into five buckets. Claim rejection or partial settlement accounted for 42 per cent of all health insurance grievances in FY25, making it the dominant complaint type. Delay in claim settlement was second at 24 per cent. Policy servicing issues (difficulty in getting policy documents, endorsements, or renewal notices) accounted for 16 per cent. Premium-related disputes (unexpected hikes, incorrect loading) were 11 per cent. Miscellaneous issues, including mis-selling complaints, made up the remaining 7 per cent.
The claim rejection category is particularly concerning. IRDAI further breaks this down: 38 per cent of rejection complaints related to pre-existing condition exclusions where the policyholder believed their condition should have been covered; 28 per cent related to proportionate deductions due to room rent sub-limits; 18 per cent related to exclusions the policyholder was unaware of; and 16 per cent related to documentation disputes.
Resolution Rates
The overall grievance resolution rate across all health insurers was 86.4 per cent within the mandated 15-day timeframe. However, the range was wide: ManipalCigna resolved 96 per cent within 15 days, while National Insurance managed only 71 per cent. IRDAI has warned that insurers consistently failing the 15-day resolution mandate will face business restrictions starting FY27.
Escalation to Ombudsman
Of the 4.82 lakh grievances filed through IGMS, approximately 48,000 (10 per cent) were escalated to the Insurance Ombudsman after the policyholder was dissatisfied with the insurer's resolution. The Ombudsman ruled in favour of the policyholder in approximately 34 per cent of cases, indicating that a significant proportion of insurer rejections and resolutions do not withstand independent scrutiny.
What This Data Tells You
Before buying or renewing a health insurance policy, check the insurer's grievance rate on IRDAI's IGMS portal. An insurer with a rate significantly above the industry average of 118 per 10,000 policies is statistically more likely to give you a difficult claims experience. Pair this with the claims settlement ratio and turnaround time data to build a complete picture. A claim estimator tool can help you model potential settlement outcomes based on your specific policy terms and the insurer's historical patterns.
Source
IRDAI Grievance Statistics FY2024-25; Integrated Grievance Management System (IGMS) annual data