Must See the Companies With Most Health Insurance Complaints in India 2025. See Ombudsman data, IRDAI reports, and tips before buying a policy.
Overview of Health Insurance Complaints in India
Health insurance is one of the most important financial protections for Indian families. But before choosing a policy, it is equally important to know how well companies handle complaints and settle claims. Every year, the Insurance Regulatory and Development Authority of India (IRDAI) publishes reports on grievance data and claim ratios, while the Insurance Ombudsman highlights the insurers receiving the highest number of consumer complaints.
These official records tell us a simple truth: not every company performs equally when it comes to keeping customers happy. Some insurers face thousands of complaints about delays, rejections, or unclear policy terms, while others maintain smoother service with far fewer issues.
In this article, we’ll explore the companies with the most health insurance complaints in 2025, compare their records, and help you identify the insurers that are more reliable and transparent.
(Authoritative sources: IRDAI Annual Reports, Insurance Ombudsman Portal)
Why Complaints Against Health Insurance Companies Are Rising
The number of complaints has increased in the past few years due to:
- Claim rejections or delays during hospitalization
- Complex policy terms were not explained clearly at the time of purchase
- Mismatched expectations on coverage and exclusions
- Slow customer service response times
- Growing awareness among customers about their right to complain
As more people buy health insurance in India, naturally, the number of grievances also grows.
Insurance Ombudsman Reports: Most Complained-About Health Insurers
The Insurance Ombudsman is a government-supported body that helps customers resolve disputes with insurers. Its reports show that complaints often cluster around a few big health insurers. These complaints usually include delays in claim settlements, unfair denials, and misleading sales practices.
Anyone can access the Ombudsman’s official portal here to check the latest updates and file a complaint.
Public Data Availability from the Sources
- IRDAI (Insurance Regulatory and Development Authority of India)
- Offers access to Annual Reports and the Handbook on Indian Insurance Statistics, these documents typically contain statistics such as grievance numbers, complaint ratios, and claim settlement data. IRDAI
- However, the 2025 data from these documents is not available via the sections we reviewed. You will need to download the Annual Report 2023–24 or the latest Handbook to check if 2025 figures are included or referenced. IRDAI
- Insurance Ombudsman (Council for Insurance Ombudsmen)
- The site includes a Publications section that lists Annual Reports. CIO India
- Yet, we couldn’t access any specific tables or summary statistics publicly concerning the number of cases handled or complaint ratios for 2025.
Summary Table: Data Availability
| Source | 2025 Complaints/Claim Ratios Published? |
| IRDAI Annual Reports / Handbook | Not directly accessible online download needed |
| Insurance Ombudsman Annual Reports | Not publicly visible reports need to be checked |
| IRDAI Consumer Grievance Portal | Process info only, no statistics provided |
| Ombudsman Complaint Portal | Process guidance only, no complaint data publicly shown |
Top Companies With the Highest Health Insurance Complaints in 2025
As per available consumer grievance data and recent case trends, the insurers that often appear with high numbers of complaints in 2025 are:
- Star Health and Allied Insurance – high number of disputes related to claim rejection.
- Niva Bupa Health Insurance – frequent complaints around pre-authorization delays.
- Care Health Insurance – customer dissatisfaction with claim processing speed.
- ICICI Lombard Health Insurance – issues related to policy terms and exclusions.
- New India Assurance (Health Segment) – common grievances on renewal clarity.
Note: Complaint volumes do not always mean a company is bad. Larger companies with more customers naturally face more grievances.
Regular Issues Customers Face With Health Insurance Policies
Most health insurance complaints fall into a few main categories:
- Claim rejections due to pre-existing conditions or exclusions
- Delays in settlement after hospitalization
- Hidden terms not explained during purchase
- High premium increases at renewal
- Poor customer service when raising grievances
Knowing these issues in advance can help customers ask the right questions before buying.
Claim Settlement Ratio vs. Complaint Ratio: What Matters More?
Many buyers only check the claim settlement ratio (CSR) when choosing an insurer. While CSR shows how many claims are approved, it does not reflect the ease of the process.
The complaint ratio, which shows the number of grievances against an insurer, gives a clearer picture of customer experience. The best approach is to look at both CSR and complaint ratio together before making a choice.
Comparison of Leading Insurers: Complaints vs. Customer Satisfaction
When comparing insurers:
- Some large companies have high complaints but also high settlement volumes, meaning they process a lot of claims overall.
- Smaller or newer insurers may have fewer complaints but also fewer customers.
- Customer satisfaction surveys reveal that responsiveness and transparency matter more than just numbers.
A smart buyer balances complaint data with overall service quality before choosing.
IRDAI Data on Health Insurance Complaints in India
The IRDAI publishes detailed annual reports on customer grievances across insurers. These reports classify complaints such as mis-selling, policy servicing, claim settlement, and others.
You can check the latest reports directly at IRDAI’s official website. This is the most reliable source for authentic complaint statistics in India.
How to Identify Companies With Poor Complaint Handling Records
To spot insurers with poor complaint handling:
- Check the IRDAI complaint ratio.
- See the Ombudsman case history against the company.
- Read verified customer reviews, not just promotional websites.
- Look at how quickly insurers respond to grievances.
Companies that delay or deny complaints regularly may not be a safe choice for customers.
How can I check complaints against health insurance companies?
You can check complaints through two official sources:
- IRDAI Annual Reports on grievances, available on irdai.gov.in
- Insurance Ombudsman Annual Reports, available on cioins.co.in
Both publish yearly data showing how many complaints each insurer received and how they were resolved, helping customers make informed decisions before buying a policy.
How does IRDAI handle health insurance complaints in India?
IRDAI requires all insurers to first resolve complaints through their internal grievance redressal system. If not resolved, customers can escalate the issue on the IRDAI Grievance Portal (IGMS). The authority monitors complaint data, publishes reports, and can take regulatory action against insurers with poor records. This ensures accountability and transparency in the health insurance sector.
Best Health Insurance Companies With the Fewest Complaints
While some insurers face more complaints, a few stand out with better complaint management and higher customer satisfaction. In 2025, insurers such as:
- HDFC ERGO Health Insurance
- Aditya Birla Health Insurance
- SBI Health Insurance
It is reported to handle grievances more efficiently compared to competitors.
Recommended External Links:
- IRDAI Annual Reports on Grievances – https://irdai.gov.in
- Insurance Ombudsman Official Portal – https://cioins.co.in
Steps to File a Complaint Against a Health Insurance Company in India
If you face a problem with your health insurer, follow these steps:
- Contact the insurer’s grievance redressal officer first.
- If not resolved in 30 days, escalate the complaint to IRDAI’s grievance cell.
- Still unsatisfied? File a complaint with the Insurance Ombudsman through the official portal.
- Keep all documents, claim records, and communications safe to support your case.
This process ensures fair treatment and accountability.
How Complaints Impact Policyholders’ Trust and Buying Decisions
High complaint numbers directly influence customer trust. Policyholders today check complaint data before making buying decisions. Insurers that fail to manage grievances often lose credibility, while those who handle complaints transparently gain long-term loyalty.
Trust is now as important as low premiums when customers pick a health insurance company.
Conclusion
Choosing the right health insurance company is not only about premiums and benefits. It is about trust, complaint handling, and timely claim settlement. From the IRDAI and Ombudsman data, we can clearly see that some insurers consistently attract more grievances, while others manage to build stronger customer satisfaction.
If you are buying a policy in 2025, focus on companies with low complaint ratios and strong settlement records. This ensures that when you or your family need medical support, your insurer will stand by you without unnecessary hurdles.
Looking for reliable options? Start by comparing insurers with the fewest complaints and download our free guide on “How to Choose the Right Health Insurance in India” to make a confident decision.
Frequently Asked Questions
Which health insurance company has the most complaints in India?
As of 2025, Star Health, Niva Bupa, and Care Health Insurance are among the companies that frequently receive the highest number of complaints, especially regarding claim rejections and delays. However, exact figures are best verified through IRDAI annual grievance reports.
How can I check complaints against health insurance companies?
You can check complaints against insurers by reviewing IRDAI’s annual grievance reports on their website and by visiting the Insurance Ombudsman portal. Both sources provide authentic information about complaint volumes and resolution status.
What are the common reasons for health insurance complaints?
The most common reasons include claim rejection due to hidden exclusions, delays in settlement, sudden premium hikes, mis-selling by agents, and poor customer service during emergencies.
Which health insurance company has the least number of complaints?
Insurers like HDFC ERGO, Aditya Birla Health, and SBI Health Insurance have fewer recorded complaints in recent years, largely due to better grievance redressal and transparent claim handling.
How does IRDAI handle health insurance complaints in India?
IRDAI collects and publishes complaint data, monitors insurers’ handling of grievances, and directs companies to resolve issues within a set timeframe. If not resolved, policyholders can escalate cases further to the Ombudsman.
Can I complain directly to the Insurance Ombudsman about my insurer?
Yes. If your complaint is not resolved by the insurer within 30 days, you can approach the Insurance Ombudsman directly through its official portal. The Ombudsman provides a fair and free dispute resolution process.
Do high complaints mean a health insurance company is bad?
Not always. Larger insurers naturally face more complaints due to their customer base. What matters more is how quickly and fairly they resolve those complaints. A company with high complaints but strong redressal can still be reliable.
Disclaimer
This information is based on my personal experience and analysis, using facts and data available from official sources. It is intended for general informational purposes only.
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