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Insurance Ombudsman: There is competition among people to get health insurance. To avoid huge expenditure of money due to fear of any untoward incident, people get health insurance. But how many people are benefited by health insurance has been exposed. This has been revealed from the report of insurance regulator Insurance Regulatory Development Authority i.e. IRDAI.
According to the report, only 71 percent of the claims are settled under health insurance. However, public sector insurance companies have a good record in this matter. These companies paid 103 percent of the claims. Only Rs 83,493 crore was paid under health insurance in the financial year 2024. Whereas health insurance companies received Rs 1.1 lakh crore as premium. It may be noted that the Insurance Ombudsman received 34,336 complaints under health insurance in a year.
Claim of Rs 26 thousand crore rejected
According to IRDAI data, payment of claims worth Rs 26 thousand crores was refused in a year. Of these, claims worth Rs 15,100 crore were refused payment due to non-compliance with the terms and conditions of the policy contract. Similarly, payment of claims worth about Rs 10,937 crore under three lakh 60 thousand policies was rejected. Claims of 7,584 remained outstanding for payment. Out of the insurance premiums worth Rs 1 lakh 10 thousand crore collected in a year, Rs 40,993 crore was received by government insurance companies. Similarly, Rs 34,503 crore was received by private insurance companies and Rs 32,180 crore was received by standalone insurance companies.
Maximum complaints in Pune, Mumbai, Ahmedabad, Chandigarh
The Insurance Ombudsman received the highest number of complaints against insurance companies in Pune, Mumbai, Ahmedabad and Chandigarh. The Insurance Ombudsman decided 6,235 complaints out of a total of 34 thousand health insurance complaints in favor of the policy holder.
