Complaints related to health insurance policies recorded a sharp rise in FY25, with claim related disputes emerging as the main area of concern, according to the annual report released by the Insurance Regulatory and Development Authority of India.
Complaints about health insurance policies increased 41% to 1,37,361 in FY25 compared with 97,503 complaints recorded in FY24. Issues linked to claim settlement dominated the grievance data, highlighting operational stress points in the sector.
Complaints related to life insurers stood at 1,20,429 in FY25, taking total insurance sector grievances to 2,57,790 during the year.
Nearly 7 out of 10 complaints in the general and health insurance segments were linked to claims refusal, delays in settlement, partial claim payments and disputes over documentation.
This pattern indicates that claim processing, rather than policy purchase, remains a major friction point for policyholders.
Health insurance policies can generate multiple claims within a single policy year, unlike life insurance. This leads to frequent interactions between insurers, hospitals and customers, increasing the likelihood of disagreements over admissibility, billing practices and package limits.
Complaints against standalone health insurers rose 33% to 46,151 in FY25. The increase was observed across private sector insurers with double digit growth in complaints, while some public sector insurers recorded more than 100% year on year rise.
Industry data points to medical inflation and hospital billing practices as key contributors to disputes. In several cases, total claim outgo exceeded premium collections, leading to tighter claim scrutiny.
Cashless treatment disputes also arose when hospital charges exceeded insurer package rates, exclusions surfaced at the claim stage, or pre authorisation approvals were revised.
Life insurance grievances were largely concentrated around survival benefits, maturity payouts, policy servicing issues and unfair sales practices, rather than death claim settlements.
The regulator highlighted mis selling and incorrect product recommendations as continuing concerns. Insurers have been directed to conduct root cause analysis of complaints and strengthen oversight of agents, brokers and digital distribution channels.
The FY25 data from IRDAI shows a significant rise in health insurance complaints, primarily driven by claim related disputes and settlement processes. The contrast with life insurance grievances reflects differing operational challenges across insurance segments.
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Published on: Feb 7, 2026, 9:57 AM IST
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