The latest figures from India’s Council of Insurance Ombudsman (CIO) and the Insurance Regulatory and Development Authority of India (IRDAI) for FY2024–25 indicate a concentration of policyholder complaints in the health segment, with stand-alone health insurers featuring prominently in the statistics.
The CIO Annual Report 2024–25, cited by The Economic Times, shows that Star Health & Allied Insurance Co. Ltd accounted for 12,186 complaints during the year, including cases carried forward from the previous period as well as new grievances filed in FY2024–25. Care Health Insurance Ltd was next with 4,423 complaints, followed by Niva Bupa Health Insurance Co. Ltd with 3,983 complaints. National Insurance Co. Ltd was the only public sector insurer among the top five by complaint volume, with 1,890 complaints. Aditya Birla Health Insurance Co. Ltd reported 2,354 complaints over the same period. Read together with the IRDAI Handbook on Indian Insurance Statistics 2024–25, the Ombudsman data are presented on a normalised basis by tracking complaints per 100,000 persons covered. This approach allows comparison of complaint incidence across insurers with very different portfolio sizes and mixes.
On a lives-covered basis, Star Health’s 12,186 complaints for 23.78 million persons insured translate into about 51 complaints per 100,000 policyholders, the highest ratio in the CIO table. Care Health – with 25.549 million lives covered – recorded roughly 17 complaints per 100,000 people, while Niva Bupa’s 3,983 complaints across 21.675 million covered lives equate to about 18 per 100,000. Aditya Birla Health’s 2,354 complaints over 18.962 million persons insured correspond to around 12 complaints per 100,000 lives.
Among public sector and composite general insurers with substantial health portfolios, complaint ratios are lower on this normalised basis. National Insurance’s 1,890 complaints over 40.731 million covered lives work out to around five complaints per 100,000 policyholders. The New India Assurance Co. Ltd reported 1,706 complaints for 80.847 million covered lives, or roughly two complaints per 100,000. ICICI Lombard General Insurance Co. Ltd, with 974 complaints and 40.899 million lives covered, also recorded about two complaints per 100,000.
HDFC Ergo General Insurance Co. Ltd registered 1,542 complaints related to 15.654 million covered lives, resulting in roughly 10 complaints per 100,000 people. The Oriental Insurance Co. Ltd reported 1,456 complaints for 14.790 million lives covered, also around 10 complaints per 100,000. United India Insurance Co. Ltd reported the largest number of people covered in the table, at 168.779 million lives, and received 876 complaints. This equates to approximately one complaint per 100,000 policyholders, the lowest ratio among the insurers listed in the CIO data. The covered lives data include government health schemes, group insurance arrangements, individual family floater policies, and other individual plans. The ratios are calculated by dividing total complaints by the number of persons insured and multiplying the result by 100.
In the life segment, IRDAI’s Annual Report 2024–25 indicates a change in the composition of complaints, with mis-selling and other unfair business practice grievances forming a larger share of total cases. According to the regulator, complaints categorised under unfair business practices increased to 26,667 in FY2024–25 from 23,335 in FY2023–24, a rise of about 14% year on year. These cases represented 22.14% of total complaints against life insurers, compared with 19.33% in the prior year. While overall complaint volumes against life insurers did not show a sharp escalation, a greater proportion of grievances now relate to how products are sold, explained, and serviced.
In its report, IRDAI sets out its view of mis-selling, stating: “Mis-selling in the Indian insurance sector is a significant concern that involves the sale of insurance products to consumers without proper disclosure of terms, conditions, or suitability.” The authority indicates that insurers are expected to go beyond individual case resolution towards more structured analysis of underlying causes. “Insurers are encouraged to tackle the problem of mis-selling by conducting a root cause analysis to identify the underlying causes. To prevent or reduce mis-selling, insurers have been advised to implement strategies such as assessing product suitability, implementing distribution channel-specific controls, and developing a plan to address mis-selling grievances, including carrying out a root cause analysis on a periodic basis,” the report states.
IRDAI data show that survival benefit claims, policy servicing issues, and unfair business practices together account for a significant share of life sector grievances. Products that combine protection with savings or investment elements are frequently involved in these complaints, raising recurring questions about suitability assessments, disclosure standards, and intermediary remuneration structures. The regulator notes that India’s life insurance market continues to rely heavily on intermediated distribution. Corporate agents, including bancassurance partners, contributed nearly 53% of private life insurers’ individual new business premium in FY2024–25, with banks alone accounting for more than 49%. Direct channels generated just over 10% of individual new business premium, while online and web aggregators together contributed less than 1%. This distribution profile places much of the conduct and suitability risk at the point of sale within bank and corporate agent networks rather than in direct or digital channels.
The regulator further elaborated its expectations on conduct and complaint handling at a Nov. 26 meeting with chief compliance officers (CCOs) and grievance redressal officers (GROs) from all insurers, where insurance ombudsmen from Bhopal and Thane reported on trends and operational issues in escalated disputes. Opening the session on India’s Constitution Day, IRDAI chair Ajay Seth emphasised the role of trust in insurer–policyholder relationships and the relevance of compliance and grievance functions across product, servicing, and claims stages. He told participants: “Compliance cannot be a department – it must be a mind-set. And grievance redressal cannot be the end of a process– it must be our early warning system. When in doubt, choose the customer. If we do that consistently, trust will follow, growth will follow, and the industry will stand stronger than ever.” He described CCOs and GROs as the “conscience and credibility” of insurance companies.
IRDAI asked insurers to clearly distinguish between service requests and complaints to avoid misclassification, strengthen internal systems to meet resolution timelines, and use grievance data as an input into risk management rather than treating it only as a compliance requirement. For insurance professionals in Asia tracking developments in India, the combined Ombudsman and IRDAI data provide a case study of how complaint ratios, mis-selling patterns, and governance expectations are shaping supervisory engagement in a major regional market.
