IRDAI data · FY2024-25
What Happens When an Insurer Says No
If a claim is rejected and the insurer will not move, the Insurance Ombudsman is the next step. It is free, it does not need a lawyer, and an award binds the insurer but not you. This is what actually happened at all 18 centres last year.
Key takeaways
- The Ombudsman is free, you do not need a lawyer, and the insurer is bound by an award you accept. You must complain to the insurer first and give it 30 days.
- 60,304 complaints were handled across the three segments in FY2024-25. Most close quickly: 79% of health, 85% of life and 88% of general cases were disposed within three months.
- Of 18,171 formal awards, 51% went in the policyholder's favour. On health it is 56% and on general 51%, so the odds are better than most people assume.
- Where you complain matters more than it should. Patna awards for the policyholder 81% of the time and Delhi 10%, on the same rules.
- An award is not the only good outcome. Many complaints end in a recommendation the insurer accepts, or are withdrawn once the insurer settles.
The three segments
Complaints handled in FY2024-25, how quickly they closed, and who the formal awards favoured.
| Segment | Complaints | Closed in 3 months | Formal awards | Awards for the policyholder |
|---|---|---|---|---|
| Health insurance | 37,585 | 79% | 11,027 | 56% |
| Life insurance | 17,330 | 85% | 5,354 | 41% |
| General insurance | 5,389 | 88% | 1,790 | 51% |
Health insurance, by centre
Health is the largest source of insurance complaints in India by a wide margin.
| Centre | Complaints | Closed in 3 months | Awards | For the policyholder |
|---|---|---|---|---|
| Mumbai | 5,810 | 48% | 1,030 | 73% |
| Pune | 5,178 | 40% | 1,051 | 43% |
| Ahmedabad | 3,540 | 100% | 1,793 | 60% |
| Bhopal | 3,191 | 74% | 998 | 63% |
| Chandigarh | 2,923 | 94% | 497 | 54% |
| Kochi | 2,291 | 57% | 956 | 53% |
| Kolkata | 2,044 | 100% | 745 | 26% |
| Chennai | 1,868 | 51% | 567 | 66% |
| Bengaluru | 1,723 | 77% | 488 | 70% |
| Noida | 1,601 | 100% | 699 | 41% |
| Lucknow | 1,484 | 100% | 400 | 54% |
| Hyderabad | 1,432 | 99% | 271 | 74% |
| Delhi | 1,418 | 100% | 185 | 10% |
| Jaipur | 1,300 | 94% | 643 | 56% |
| Bubaneshwar | 577 | 100% | 289 | 66% |
| Patna | 529 | 100% | 232 | 61% |
| Guwahati | 367 | 83% | 156 | 60% |
| Thane | 309 | 100% | 27 | 78% |
Life insurance, by centre
| Centre | Complaints | Closed in 3 months | Awards | For the policyholder |
|---|---|---|---|---|
| Pune | 2,597 | 28% | 670 | 50% |
| Kolkata | 2,336 | 100% | 840 | 32% |
| Delhi | 1,960 | 100% | 401 | 13% |
| Mumbai | 1,188 | 50% | 162 | 57% |
| Lucknow | 1,178 | 100% | 297 | 46% |
| Chandigarh | 1,161 | 96% | 426 | 43% |
| Noida | 1,067 | 100% | 346 | 65% |
| Patna | 886 | 100% | 263 | 51% |
| Bhopal | 723 | 76% | 320 | 23% |
| Bengaluru | 694 | 81% | 230 | 68% |
| Ahmedabad | 611 | 100% | 194 | 7% |
| Chennai | 587 | 49% | 277 | 45% |
| Hyderabad | 583 | 99% | 234 | 64% |
| Bubaneshwar | 559 | 100% | 263 | 32% |
| Jaipur | 524 | 97% | 142 | 42% |
| Kochi | 327 | 38% | 209 | 29% |
| Guwahati | 269 | 90% | 73 | 44% |
| Thane | 80 | 100% | 7 | 100% |
General insurance, by centre
Motor, fire, marine, liability and the rest.
| Centre | Complaints | Closed in 3 months | Awards | For the policyholder |
|---|---|---|---|---|
| Lucknow | 538 | 100% | 118 | 42% |
| Jaipur | 470 | 99% | 182 | 54% |
| Chandigarh | 456 | 99% | 108 | 66% |
| Mumbai | 443 | 71% | 62 | 68% |
| Noida | 422 | 100% | 149 | 32% |
| Chennai | 360 | 46% | 151 | 52% |
| Kolkata | 315 | 100% | 99 | 14% |
| Pune | 314 | 30% | 84 | 32% |
| Hyderabad | 296 | 100% | 74 | 62% |
| Delhi | 289 | 100% | 58 | 10% |
| Patna | 276 | 100% | 113 | 81% |
| Kochi | 254 | 48% | 135 | 50% |
| Guwahati | 223 | 92% | 124 | 64% |
| Bubaneshwar | 215 | 100% | 131 | 54% |
| Bengaluru | 207 | 78% | 78 | 79% |
| Ahmedabad | 163 | 100% | 82 | 52% |
| Bhopal | 133 | 79% | 42 | 38% |
| Thane | 15 | 100% | 0 | — |
How to use the Ombudsman
Complain to the insurer first and keep the acknowledgement. If the reply does not satisfy you, or 30 days pass with no reply, approach the Ombudsman for the centre covering your address, within a year of that reply.
Bring the policy schedule and wording, the claim form, the rejection letter, your correspondence, and the evidence the rejection turns on. Most complaints that fail do so because the wording genuinely excludes the loss, not because the process went wrong.
An award binds the insurer, which must comply within 30 days. It does not bind you. Reject it and your right to a consumer forum or a court survives, which is why trying the Ombudsman first costs you very little.
What the numbers do not say
A low award rate at a centre is not proof of bias. Centres differ in the mix of complaints they receive, and one handling mostly weak claims will issue fewer awards for the complainant however fairly it decides. The spread is worth knowing, not worth building a theory on.
Nor is an award the only good outcome. Many complaints end in a recommendation the insurer accepts, or are withdrawn because the insurer settled once the complaint was filed. Those never appear as awards, and for the policyholder they are wins.
Frequently asked questions
What is the Insurance Ombudsman and what does it cost?
A free adjudication service under the Insurance Ombudsman Rules, 2017, with 18 centres across India. No fee, no lawyer needed. It handles personal lines, group policies issued to sole proprietorships and micro enterprises, and complaints against insurers and their intermediaries.
When can I go to the Ombudsman?
After you have complained to the insurer and either received a reply you do not accept or heard nothing for 30 days. Normally within one year of the insurer's reply. There is a monetary ceiling on the award, so large commercial disputes go elsewhere.
How long does it take?
Faster than most people expect. Across all three segments in FY2024-25 the large majority of disposed cases closed within three months, and several centres closed every case inside that window.
What are my chances?
Of the formal awards issued in FY2024-25, 51% favoured the policyholder, and health did best at 56%. But most complaints never reach an award: they are settled, withdrawn, resolved by recommendation, or ruled outside the remit.
Is the decision binding?
An award binds the insurer, which must comply within 30 days. It does not bind you. Reject it and your right to go to a consumer forum or court survives intact. That asymmetry is why it is worth trying first.
Should I use a broker or go direct?
You can go direct and many people do. An advisor helps before that point: reading the rejection against the wording, assembling the documents, and telling you honestly whether the insurer is right. A complaint that was never going to succeed costs you months.
Related: complaint rates by insurer · claim-settlement ratios · insurer solvency · what to do before you get here.