Complaints against health insurers rise 2% in FY15

Industry players blame "lack of understanding" among customers about policies as main reason for spike

The number of customer complaints against health insurers, the second-largest portfolio in the Rs 87,000-cr non-life insurance industry, went up by 2 per cent to 25,600 in fiscal 2015 over the previous year.

According to data from General Insurance Council around 11,000 or 44 per cent complaints registered in 2014-15 were related to claim settlement, up from about 10,000 complaints in 2013-14.

The health segment commands 25 per cent of the non-life insurance business.

In policy terms, 7,000 or 29 per cent complaints were registered in 2014-15 as against 6,000 or 26 per cent complaints a year earlier, the data showed.

However, industry players have blamed "lack of understanding" among the customers regarding the policies as the main reason for the spike in complaints.

"In health insurance, the number of complaints have gone up mainly because of the lack of understanding among the insured about the policies issued to them," General Insurance Council Secretary General R Chandrasekaran told PTI.

Topping the list is the customer demanding to cover even the room rentals, which is not covered under his or her policy.

Health insurance grew by about 40 per cent in case of standalone health insurers, whereas the general insurers have grown by 25-30 per cent during last one year, he said.

The industry feels that complaints are still not alarming and they believe that the recently launched ROHINI initiative will improve things in future.

"I can only say the complaints are not alarming in both the cases and I do hope the ROHINI initiative will help addressing the complaint-related issues in the case of health insurance on time in future, as it will make the things transparent which will act as a win-win situation for both the insurers and the insured," Chandrasekaran said.

In contrast, the industry witnessed decline in the absolute number of complaints reported during the year under motor insurance segment, which is the largest portfolio for the insurers with around 40 per cent share of the industry.

Moreover, the industry saw a fall in complaints, as the number of claims handled under the segment during the year also declined.

In 2014-15, the total number of policies stood at 12.60 crore, while in 2013-14, it was around 11.50 crore. But the number of complaints remained same in terms of percentage.

Similarly, the percentage of claims settled under motor insurance also fell from 0.14 per cent in 2013-14 to 0.10 per cent in 2014-15. At 24,647 in FY15, it showed a 30 per cent fall from about 28,000 previous year, in terms of the number of complaints received by the industry during the year.

In the segment, 47 per cent or 11,611 complaints are claim-related, while 33 per cent or 8,000 complaints are policy-related.