Parliament Question: Insurance Claim Repudiation and Consumer Protection

GOVERNMENT OF INDIA MINISTRY OF FINANCE DEPARTMENT OF FINANCIAL SERVICES LOK SABHA UNSTARRED QUESTION No. 3556 ANSWERED ON MONDAY, AUGUST 10, 2026/SHRAVANA 19, 1948 (SAKA) Insurance Claim Repudiation and Consumer Protection 3556. SHRI SRIBHARAT MATHUKUMILLI: Will the Minister of FINANCE be pleased to state: (a) Whether the Government is aware of instances of insurance claims being rejected or delayed on grounds arising from ambiguous or unclear policy terms, if so, the details thereof; (b) The number and value of insurance claims repudiated in the country during each of the last five years, along with the number subsequently overturned by the Insurance Ombudsman, consumer forum or courts, State-wise particularly in Andhra Pradesh, including Visakhapatnam; (c) Whether the Government has assessed the financial impact of unjustified claim repudiation on policyholders and families, if so, the details thereof, particularly in Andhra Pradesh and Visakhapatnam; and (d) The steps being taken by the government to ensure clear and standardised policy language, prevent arbitrary claim repudiation, strengthen accountability of insurers, and provide timely grievance redressal to affected policyholders? ANSWER THE MINISTER OF STATE IN THE MINISTRY OF FINANCE (SHRI PANKAJ CHAUDHARY) (a): Insurance Regulatory and Development Authority of India (IRDAI) monitors policyholder grievances relating to repudiation of insurance claims and delay in settlement through analysis of regulatory returns submitted by insurers, supervisory reviews and complaints registered on the Bima Bharosa Portal. Based on such analysis, IRDAI undertakes appropriate regulatory, supervisory and follow-up measures, wherever necessary. Rejection or delay generally arise due to several factors, including non-disclosure or misrepresentation of material facts, incomplete, inaccurate or inconsistent documentation, exhaustion of the sum insured, non-fulfilment of policy conditions, applicability of waiting period, fraud investigations, delays in completion of loss assessment surveys, judicial proceedings in the case of Motor Third Party claims, and delay in submission of records or other information by hospitals, garages and other entities. (b): The data on insurance claims repudiated is maintained by IRDAI at the aggregate level and is not maintained State-wise or city-wise. A detail containing data of claims repudiated during last 5 years is at Annexure-I. The state-wise data on Reason for Grievance referred to Insurance Ombudsman, including any partial or total repudiation of claims by an insurer, as received from Council of Insurance Ombudsman Office is attached as Annexure-II.(c) and (d): IRDAI (Insurance Products) Regulations, 2024 and the IRDAI (Protection of Policyholders' Interests, Operations and Allied Matters of Insurers) Regulations, 2024 require Insurers to use clear, simple and policyholder-friendly language in policy documents, disclose all key features, benefits, exclusions and terms through prospectuses, provide proposal forms and policy documents in simple language (including scheduled languages, wherever feasible), offer a 30-days free-look period, publish a Citizens' Charter specifying service standards, timelines and grievance redressal mechanisms, ensure fair and timely settlement of claims. Health insurance claims can not be repudiated without approval of the Product Management Committee (PMC) or Claims Review Committee (CRC) and where delay occurs in settlement of claim, the insurer is required to pay penal interest. If the customer is not satisfied with the service of the insurer they may approach Insurance Ombudsman for redressal. Any delay in honouring the award of the Insurance Ombudsman attracts a penalty of ₹5,000 per day. In addition, the complaints can also be registered on Centralised Public Grievance Redress and Monitoring System (CPGRAMS) portal of the Government of India, which is monitored regularly from the appropriate level in Department of Financial Services (DFS) for redressal of grievances registered. These measures are applicable uniformly across the country, including Andhra Pradesh. *****Annexure-I Annexure-I referred to in part (b) of Lok Sabha Unstarred Question No. 3556 on “Insurance Claim Repudiation and Consumer Protection” answered on 10.08.2026 Death Claims of Life Insurers (i) Individual Death Claims (Number of Policies) Financial Year Claims Repudiated / Rejected Claims Paid 2020-21 12,559 10,83,623 2021-22 16,509 15,87,110 2022-23 15,173 10,60,419 2023-24 16,408 9,82,615 2024-25 17,333 10,11,880 (ii) Group Death Claims (Number of Lives) Financial Year Claims Repudiated / Rejected (Group) Claims Paid 2020-21 3,9 80 10,91,756 2021-22 11,149 14,18,442 2022-23 4,032 12,40,247 2023-24 4,459 14,80,087 2024-25 4,155 16,28,641 Source: IRDAI Handbook on Insurance Statistics (iii) Claims of General Insurers (including Health Insurance Claims) Financial Year Number of Claims Repudiated Number of Claims Paid 2020-21 8,72,085 4,03,67,244 2021-22 9,40,416 5,58,98,793 2022-23 11,50,969 6,17,17,431 2023-24 14,60,527 7,12,00,854 2024-25 16,71,436 5,92,35,233 (iv) Claims of Stand Alone Health Insurers Financial Year Number of Claims Repudiated Number of Claims Paid 2020-21 2,44,461 15,95,870 2021-22 4,77,087 29,54,721 2022-23 5,50,721 37,61,032 2023-24 5,36,339 50,27,957 2024-25 5,67,722 71,43,761 Source: IRDAI Handbook on Insurance Statistics The insurance ombudsmen deal with all types of eligible complaints registered with them, which include complaints on repudiation of claims also. The Insurance Ombudsman maintains complaints data centre- wise. The Hyderabad Centre has jurisdiction over both Andhra Pradesh and Telangana.(v) The number of insurance complaints and awards passed in favour of complainants by the Hyderabad Centre during the last five financial years is as under: Award in favour of Financial Year Total Life Insurance Complaints Complainant 2020-21 1,479 221 2021-22 1,428 241 2022-23 641 109 2023-24 766 127 2024-25 583 149 Awards in favour of Financial Year Total General Insurance Complaints Complainant 2020-21 140 27 2021-22 154 6 2022-23 114 18 2023-24 175 45 2024-25 296 46 Awards in favour of Financial Year Total Health Insurance Complaints Complainant 2020-21 496 133 2021-22 903 145 2022-23 930 189 2023-24 1,291 323 2024-25 1,432 200 Source: IRDAI Handbook on Insurance Statistics IRDAI does not maintain state-wise data regarding the rejected claims overturned by consumer forum, or courts, particularly in Andhra Pradesh, including Visakhapatnam. Total number of insurance complaints and awards passed by all courts including Hon’ble Supreme court, Hon’ble High Courts, other Courts and Consumer forum in favour of complainants is provided below: Year No of Cases decided in the Courts / forums Decided in favor of Policyholder/ Customer 2021-22 19,025 10,871 2022-23 25,790 13,442 2023-24 39,538 22,015 2024-25 44,064 23,765 2025-26 46,122 25,418 Note: Inclusive of Claims related complaintsAnnexure-II Annexure-II referred to in part (b) of Lok Sabha Unstarred Question No. 3556 on “Insurance Claim Repudiation and Consumer Protection” answered on 10.08.2026 Reason for Grievance referred to Insurance Ombudsman: Rule 13(1)(b) - Any partial or total repudiation of claims by an insurer 2021-22 2022-23 2023-24 2024-25 2025-26 Receive Disposed Receive Disposed Receive Disposed Receive Disposed Receive Disposed d during d during d during d during d during State during the Year during the Year during the Year during the Year during the Year the in favour of the in favour of the in favour of the in favour of the in favour of Year Complainan Year Complainan Year Complainan Year Complainan Year Complainan ts ts ts ts ts Andaman & 2 0 2 0 0 0 1 0 2 2 Nicobar Andhra 98 53 201 122 450 292 487 178 775 274 Pradesh ARUNACHAL 1 1 1 0 0 0 4 1 2 2 PRADESH Assam 151 72 271 154 343 197 388 206 483 351 Bihar 90 41 154 98 388 244 542 372 507 312 Chandigarh 63 36 73 57 100 76 104 48 59 9 Chattisgarh 47 12 88 54 138 79 132 70 165 81 Dadra & Nagar 0 0 14 6 6 4 5 5 13 7 Haveli Daman & Diu 0 0 2 2 3 3 8 3 8 4 Delhi 442 145 631 355 992 725 1,194 893 1,516 851 Goa 27 6 22 14 43 17 37 21 36 14 Gujarat 1,182 1,184 1,810 1,410 2,732 1,866 3,499 2,313 4,181 2,167 Haryana 400 226 923 684 1,736 1,391 1,938 1,087 1,166 410 Himachal 28 10 45 37 60 41 70 38 36 6 pradesh Jammu and 24 17 29 20 71 53 69 28 39 13 Kashmir Jharkhand 52 12 88 49 162 114 244 179 286 178 Karnataka 475 278 811 632 1,205 977 1,658 1,116 1,592 1,284 kerala 1,025 253 990 644 1,851 1,276 2,208 1,521 2,561 1,768 Lakshadweep 0 0 0 0 0 0 1 0 0 0 Madhya 369 128 913 641 2,405 1,414 2,420 1,490 2,700 1,745 Pradesh Maharashtra 3,596 1,397 3,540 1,794 5,181 2,302 5,869 1,842 7,333 3,758 Manipur 2 0 5 1 5 5 14 7 8 7 Meghalaya 8 3 7 4 8 5 7 5 8 6 Mizoram 0 0 2 0 2 1 4 1 2 2Nagaland 0 0 7 1 1 0 12 5 3 8 Odisha 238 122 367 233 617 437 627 420 645 472 Pondicherry 19 2 6 4 35 25 28 15 40 19 Punjab 278 166 491 374 1,123 926 1,311 660 607 125 Rajasthan 643 365 797 439 1,233 852 1,416 828 1,790 1,021 Sikkim 0 1 1 1 3 2 6 5 5 3 Tamil Nadu 767 266 1,014 614 1,986 1,255 1,552 806 2,371 1,298 TELANGANA 270 207 384 243 968 714 1,139 530 1,638 640 Tripura 4 3 19 13 21 13 26 16 15 10 Uttar Pradesh 819 285 1,161 589 2,030 1,268 2,439 1,422 2,587 1,073 Uttarakhand 65 21 92 41 149 100 122 63 145 33 West Bengal 757 301 1,122 460 1,804 957 1,802 931 1,862 856 Total 11,942 5,613 16,083 9,790 27,851 17,631 31,383 17,125 35,186 18,809 *****