Top 5 Health Insurance Companies by Complaints – CIO Report

Council for Insurance Ombudsmen (CIO) 2023-24 data reveals the 5 worst health insurance companies in India based on complaints and claim rejections.

One of my clients recently shared a video showing complaints against health insurance companies, based on the Council for Insurance Ombudsmen (CIO) 2023-24 data. I found it interesting and decided to share it here. Remember, though, this is 2023-24 data, and we are already in mid-2025, so its current relevance is uncertain. Still, it offers useful insight and a point of reference.

The present numbers may have changed. Some companies may have improved, while others may not. This post is not meant to damage any insurer’s reputation. I am simply sharing information from the latest CIO report available, and readers can draw their own conclusions about which companies perform best or worst.

Top 5 Health Insurance Companies by Complaints – CIO Report

Health insurance is supposed to give you financial peace when a medical emergency strikes. We buy a policy so that if we face a sudden illness, surgery, or hospital stay, the insurer will take care of the bills. Unfortunately, the reality is not always so smooth. Many people face problems like claim rejections, long delays, and confusing paperwork, turning a health crisis into a nightmare.

The good news is that you are not alone when this happens. India has a dedicated system to help policyholders resolve disputes with insurance companies: the Insurance Ombudsman, managed by the Council for Insurance Ombudsmen (CIO). Every year, the CIO releases a detailed report about the complaints received against insurers and how they were resolved.

In this article, we will walk you through the highlights of the Annual Report 2023-24, explain the trends behind health insurance complaints, and reveal the top five insurers with the worst complaint records. This will help you make an informed decision when buying or renewing your health insurance policy.

What Is the Insurance Ombudsman and Why It Matters

The Insurance Ombudsman is like a referee between you and your insurance company. It was set up in 1998 under the Redressal of Public Grievances Rules to help policyholders get justice without going to court. Over the years, the system has evolved. The latest update came in November 2023, showing the government’s continued focus on protecting consumers.

The Council for Insurance Ombudsmen (CIO) manages 17 ombudsman offices across India. It includes senior members from the insurance and finance sectors, such as the Chairperson of LIC and representatives from IRDAI. Their job is to ensure that customer complaints are handled fairly and quickly.

Key Achievements in 2023-24

The Ombudsman’s 2023-24 performance has been impressive and shows their strong commitment to policyholders:

• 52,575 complaints received and 49,705 resolved during the year.
• This represents a 43% jump in complaints resolved compared to 2022-23.
• 87% of cases were settled within 90 days of registration.
• Over 42% of complaints were solved through mediation, meaning both parties agreed on a fair settlement without long legal battles.

Nine out of seventeen centres even managed to clear all pending complaints by March 31, 2024—a huge success that shows how serious they are about quick action.

Digital Push for Faster Resolutions

Earlier, filing a complaint often meant physical paperwork and long waits. Now, the CIO has taken a big digital leap to make the process simpler and faster:

• Nearly 40% of complaints were registered online in 2023-24.
• An even higher 72% of hearings were held online, saving time and travel costs.
• Awards are now digitally signed, and you can securely download them using an OTP.
• SMS alerts and auto-mailers update complainants about every stage of their case.
• A chatbot named “Bima Lokpal Mitra” answers common questions and guides you through the process of filing a complaint.

Soon, policyholders will also get real-time tracking of complaints and automated scheduling of hearings. This shows how technology is making grievance redressal faster and more transparent.

The Biggest Problem: Claim Rejection

The most alarming part of the 2023-24 report is the reason behind complaints. A massive 95% of health insurance complaints were because insurers partially or completely denied claims. This is shocking and reveals that claim repudiation is the single biggest pain point for policyholders.

Why Do Insurers Reject Claims?

• Non-disclosure of pre-existing conditions.
• Misunderstanding or miscommunication about policy coverage.
• Insurers sticking to outdated rules about hospitalization or procedures.

Ombudsman Recommendations

The report gives several suggestions to improve this situation:

1. Utmost Good Faith (Uberrima Fides): Insurance is based on honesty from both sides. Policyholders must disclose all health details—past illnesses, treatments, and conditions—when buying a policy. Hiding facts is a sure way to face a claim rejection later.
2. Clear Explanation of Policy Terms: Insurers should explain complicated clauses like “Reasonable & Customary Charges” in simple language. Many people are unaware of these limits until their claims are reduced.
3. Update Rules for Modern Treatments: Medical science is evolving. Many surgeries no longer need a full 24-hour hospital stay, but some insurers still reject claims based on old requirements. The Ombudsman urges them to update their policies.
4. Transparent Specialist Fees: Policies must clearly mention whether fees charged by specialists or surgeons during hospitalization are covered. This will prevent confusion when hospitals issue separate bills.
5. Fraud Control: To fight fake claims that raise everyone’s premiums, the Ombudsman recommends sharing fraud data across insurers, filing police complaints when needed, and blacklisting fraudulent hospitals.

Top 5 Worst Health Insurance Companies (Based on 2023-24 CIO Report)

The CIO report also highlights which insurers received the most complaints and delays. This data is a goldmine for anyone shopping for health insurance. Below are the top five companies with the highest number of complaints and cases where the Ombudsman ruled against them.

Detailed Look at the Worst Performers

1. Star Health and Allied Ins. Co. Ltd.
   • Complaints Received: 12,594 – This is by far the highest number of health insurance complaints received by any insurer, signaling significant customer dissatisfaction.
   • Complaints Outstanding: 1,828 – They also had the highest number of unresolved complaints at the end of the financial year.
   • Complaints Disposed Above 1 Year: 1,828 – Worryingly, this is the highest number of complaints that took over a year to resolve, indicating severe operational delays.
   • Awards & Recommendations in Favour of Complainant: 7,506 – The ombudsman found this company at fault in the highest number of cases, suggesting a high proportion of justified grievances from policyholders.
2. Care Health Ins. Ltd.
   • Complaints Received: 3,419 – This company received the second-highest volume of health insurance complaints.
   • Complaints Outstanding: 291 – They had the third-highest number of unresolved complaints.
   • Complaints Disposed Above 1 Year: 13 – While this specific number is lower compared to some others, the overall high volume of received and outstanding complaints indicates broader issues in their service.
   • Awards & Recommendations in Favour of Complainant: 1,687 – This is the second-highest number of instances where the ombudsman ruled against the company.
3. NIVA BUPA HEALTH INSURANCE CO.LTD
   • Complaints Received: 2,399 – This company received the third-highest number of health insurance complaints.
   • Complaints Outstanding: 287 – They had the fourth-highest number of unresolved complaints.
   • Complaints Disposed Above 1 Year: 428 – A substantial number of complaints took over a year to resolve, highlighting significant delays in their resolution process.
   • Awards & Recommendations in Favour of Complainant: 1,297 – The third-highest number of awards and recommendations were made against this company.
4. National Insurance Co. Ltd.
   • Complaints Received: 1,923 – This public sector insurer received the fifth-highest number of health insurance complaints.
   • Complaints Outstanding: 283 – They recorded the fifth-highest number of outstanding complaints.
   • Complaints Disposed Above 1 Year: 165 – A notable number of cases took more than a year to conclude, indicating prolonged resolution times.
   • Awards & Recommendations in Favour of Complainant: 1,015 – The fourth-highest number of adverse findings by the ombudsman were against this company.
5. The New India Assurance Co. Ltd.
   • Complaints Received: 1,300 – While lower than the top, this still places them among the high complaint getters for health insurance.
   • Complaints Outstanding: 592 – This is the second-highest number of outstanding complaints, indicating a significant backlog of unresolved issues.
   • Complaints Disposed Above 1 Year: 535 – They rank second in taking over a year to resolve complaints, pointing to severe delays in their resolution process.
   • Awards & Recommendations in Favour of Complainant: 530 – A considerable number of justified complaints were found against this insurer by the ombudsman.

These numbers show that both private and public sector insurers have serious service gaps, and policyholders should carefully consider these records before buying.

Lessons for Policyholders

The data sends a strong message to all of us:

• Don’t be blinded by low premiums. A cheaper policy means nothing if the company delays or denies claims.
• Check complaint records before buying. You can access these reports online.
• Disclose everything honestly when applying for a policy—health conditions, past treatments, lifestyle habits.
• Read policy terms carefully. Understand exclusions, room rent limits, and waiting periods.
• Claim rejected does not mean insurer is bad – We have a common notion to believe that if the company rejected the claim, then the company is bad. However, there are various reasons for rejections, and many times, we, policyholders unable to understand what is covered and what is NOT.

Remember, utmost good faith is a two-way street: you must be truthful, and insurers must be fair.

How to Fight Back if Your Claim Is Rejected

A claim rejection isn’t the end of the road. Here’s a clear, step-by-step action plan to help you challenge a denial:

1. Understand the Rejection Letter
   Read it line by line. Identify the specific policy clause cited. Compare it with your policy wording to check for errors or misinterpretations.
2. Gather Strong Evidence
   Collect every relevant document: policy schedule, proposal form, premium receipts, hospital bills, diagnostic reports, and all email or call records with the insurer or TPA.
3. Approach the Insurer’s Grievance Cell
   Send a written complaint to the company’s Grievance Redressal Officer. Quote your claim number, explain why the rejection is unfair, and attach evidence.
   Timeline: Insurer must respond within 15 days.
4. Escalate to IRDAI (IGMS)
   If unsatisfied, register the complaint on the Integrated Grievance Management System at igms.irda.gov.in or call 155255. IRDAI monitors and nudges the insurer to resolve it.
5. File a Case with the Insurance Ombudsman
   If the insurer still fails, approach the Ombudsman online at cioins.co.in within one year of the insurer’s final response.
   Hearings can be virtual, decisions usually come within 90 days, and the award is binding on the insurer—and it’s free.
6. Consumer Court as a Last Resort
   If all else fails, you can approach the District, State, or National Consumer Commission (depending on claim amount) within two years of the dispute. Lawyers are optional for smaller claims.

Pro Tips to Avoid Rejections Altogether

• Disclose all medical history honestly.
• Understand waiting periods and sub-limits before signing.
• Use cashless network hospitals to reduce disputes.
• Keep policy details and contact info updated.

The Road Ahead

The CIO is not stopping here. For 2024-25, they aim to:

• Dispose of complaints within three months.
• Achieve 70% online complaint registration.
• Add new features to the Complaint Management System for easier access.
• Launch a revamped website for better user experience.

These steps will especially benefit health policyholders because health insurance consistently generates the highest number of complaints.

Final Thoughts

The Insurance Ombudsman has become a powerful ally for policyholders. With faster resolutions, digital processes, and public reporting, they are pushing insurers to be more accountable.

But the 2023-24 report is also a warning. Claim repudiation is still a huge problem, and some insurers repeatedly fail their customers. Before buying or renewing your policy, look beyond glossy brochures and low premiums. Study the insurer’s complaint history, resolution speed, and customer service track record.

Health insurance is not just about paying a premium; it’s about trust that your insurer will stand by you in tough times. Use this data to pick a company that values that trust as much as you do.

Stay informed, stay healthy, and make sure your Bima Bharosa (insurance trust) is with a company that truly deserves it.