A recent report published by The Economic Times on 08 December 2025 highlights a worrying trend in India’s health insurance sector. According to data shared by the Insurance Ombudsman, health insurance complaints have doubled over the last six years and now account for nearly 80 percent of all insurance-related grievances in the country.

This sharp rise exposes serious gaps in claim settlement practices and explains why so many policyholders struggle to receive the benefits they rightfully deserve.

Health Insurance: The Largest Source of Insurance Grievances

The Ombudsman’s data clearly shows that health insurance has become the most problematic insurance segment for consumers. While health insurance penetration has increased, claim disputes have grown at a much faster pace.

The majority of complaints relate to:

Claim rejection

Partial settlement

Delays in claim approval

Disputes over policy terms and exclusions

This trend indicates that buying a health insurance policy is no longer the biggest challenge—getting a claim settled is.

Top Reasons for Health Insurance Claim Rejections

The Insurance Ombudsman has identified key reasons why health insurance claims are rejected:

1. Non-Disclosure of Pre-Existing Diseases

Many claims are denied on the grounds of alleged non-disclosure, even when the policyholder was unaware of a medical condition or when the illness had no direct link to the current treatment.

2. Policy Exclusions and Waiting Periods

Claims are often rejected due to:

Specific disease exclusions

Waiting period clauses

Interpretation disputes over what is covered

Policyholders frequently discover these exclusions only at the time of claim, not at purchase.

3. Documentation and Procedural Issues

Incomplete medical records, billing discrepancies, or delayed submission of documents are commonly cited reasons for rejection, even in genuine medical emergencies.

4. Medical Necessity Disputes

Insurers increasingly question the medical necessity of procedures, hospital stays, or advanced treatments, leading to partial payments or outright rejection.

Growing Trust Deficit Between Insurers and Policyholders

The report highlights a widening trust gap in the health insurance ecosystem. While insurers rely heavily on technical clauses and policy wording, policyholders expect protection during medical emergencies.

As claim amounts increase, insurers tend to conduct deeper scrutiny, resulting in delays, repeated queries, and eventual rejections—causing financial and emotional distress to families.

Why Ombudsman Complaints Are Rising

With limited success in resolving issues directly with insurers, more policyholders are now approaching:

Insurance Ombudsman offices

IRDAI grievance portals

Consumer forums

However, high complaint volumes have also led to pendency and delayed hearings, prompting recent proposals to reform the ombudsman system.

What Policyholders Should Do If Their Claim Is Rejected

The Ombudsman’s findings underline the importance of timely escalation and expert handling of rejected claims. Policyholders should:

Seek a written rejection letter with reasons

Challenge unjust rejection with medical and policy evidence

Escalate to IRDAI or the Insurance Ombudsman when needed

Many rejections are reversible when approached correctly.

How ReClaimHub Supports Policyholders

At ReClaimHub.in, we specialise in:

Reviewing rejected health insurance claims

Identifying unfair or incorrect rejection grounds

Drafting strong representations to insurers

Escalating cases to IRDAI and the Insurance Ombudsman

With health insurance complaints rising rapidly, professional claim support is no longer optional—it is essential.

Conclusion

The doubling of health insurance complaints over six years is a clear warning sign. While health insurance is meant to provide security, increasing claim rejections are undermining consumer confidence.

Awareness, timely action, and expert assistance can make the difference between a denied claim and a successful settlement.