As a seasoned insurance dispute lawyer in Kerala, practicing before the Consumer Commission and Insurance Ombudsman Kochi, I’ve helped many clients successfully resolve such complaints. In this detailed guide, I’ll explain how to file a complaint against an insurance company in India—step-by-step.

1. Understand Your Rights as a Policyholder

Under the Insurance Act, 1938 and IRDAI regulations, insurance companies are duty-bound to handle claims fairly, transparently, and within a reasonable time. Any delay, rejection without valid reason, or mis-selling can be legally challenged.

Typical issues include:

· Rejection of valid health insurance claims

· Delay in life insurance death claim settlement

· Denial of cashless hospitalization without justification

· Misrepresentation of policy terms at purchase

· Policy lapse due to non-communication

· Partial settlement without explanation

2. Step One: File a Complaint with the Insurer’s Grievance Cell

Start by filing a written complaint with your insurance company’s Grievance Redressal Officer (GRO). Include:

· Policy number and claim ID

· Description of the issue

· Supporting documents like bills, emails, rejection letters

IRDAI mandates that insurers respond within 15 days. If they fail to resolve the issue, proceed to the next level.

3. Step Two: Escalate to the Insurance Regulatory Authority (IRDAI)

If the insurer doesn’t act fairly, you can approach the IRDAI Grievance Cell:

· Online: https://igms.irda.gov.in

· Email: complaints@irdai.gov.in

· Toll-free helpline: 155255

Attach all earlier correspondence, including the insurer’s response (or lack thereof).

4. Step Three: File a Complaint with the Insurance Ombudsman

If the claim amount is within ₹30 lakhs, the Insurance Ombudsman offers a quick, cost-free, and legally binding dispute resolution system.

You can approach the Insurance Ombudsman in Kochi if:

· Your complaint has not been resolved within 30 days

· You are not satisfied with the insurer’s response

· The dispute involves mis-selling, policy lapses, delays, or unfair rejection

How to file:

· Submit Form P-II (available on www.cioins.co.in)

· Include a copy of your complaint and insurer’s response

· Attach all claim-related documents and correspondence

There is no requirement for an advocate, but professional legal drafting can greatly increase your success rate. As an insurance claim lawyer in Ernakulam, I provide legal representation before the Ombudsman to ensure your complaint is strong, clear, and supported by IRDAI regulations.

5. Step Four: Approach the Consumer Commission

If your grievance exceeds ₹30 lakhs or involves a serious deficiency in service, fraud, or mental agony, you may file a case before the District, State, or National Consumer Disputes Redressal Commission depending on the amount claimed.

Key benefits:

· Right to claim compensation for financial loss, stress, and litigation expenses

· Right to challenge insurance malpractices

· Binding orders with enforcement rights

I represent clients as a consumer court lawyer in Kochi and help them draft petitions, affidavits, evidence submissions, and final arguments across all stages of the consumer commission process.

6. What Documents Are Required?

To strengthen your case, you must gather:

· Copy of your insurance policy

· Claim form and rejection letter

· All bills and hospital records (for health/life claims)

· Email/SMS communication with insurer

· Proof of payment (premium receipts, bank statements)

· Copies of correspondence with IRDAI and/or Ombudsman

7. When Should You Seek Legal Help?

If you face:

· Complex legal rejection grounds (e.g., "non-disclosure", "pre-existing illness")

· Lack of response from the insurer

· Delay beyond 30 days

· Partial or arbitrary deductions

Then consult a qualified insurance dispute lawyer. Legal support can help with:

· Complaint drafting

· Legal notices under IRDAI rules

· Representation before the Ombudsman or Commission

· Filing execution petitions if awards are not honoured

Insurance complaints in India are rising. But policyholders who take the right legal steps often succeed. As a dedicated health insurance claim lawyer, life insurance advocate, and consumer court specialist in Kochi, I ensure every client's complaint is handled professionally, ethically, and efficiently.

Need Help with Your Insurance Complaint?

Whether you’re dealing with a rejected health claim, delayed life insurance payout, or unfair deductions in a motor insurance settlement — I’m here to assist. Contact me today for a consultation or visit RPR Legal Nexus, Kochi.

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