Your Insurer Got 10,000 Complaints Last Year. Here’s Who.
You bought insurance. You pay your premiums on time. You assume your family is covered.
But when your family files a claim and the insurer says no, what happens next? Most people don’t know. Most families don’t know. They’ve never heard of the Insurance Ombudsman, and they certainly don’t expect to need one.
The Council for Insurance Ombudsmen (CIO) just published its annual report for FY 2024-25. It tells you which insurers fight claims, which families had to fight back, and how many are still waiting for an answer.
This isn’t a name-and-shame ranking. It’s a lens into what your family might face if things go wrong.
What the Insurance Ombudsman Actually Does
The Insurance Ombudsman is a free, independent body that handles complaints where the insurer has already said no. Refused your claim, delayed the payout, or shortchanged the amount. If the insurer’s internal grievance process didn’t work, you escalate here.
The ombudsman can issue binding recommendations for disputes up to ₹50 lakh. No lawyers needed. No fees.
If your family ends up here, it means they’ve already been told no by the insurer. They’ve already waited. They’ve already been turned away once. The ombudsman is the next step, and most families don’t even know it exists.
If you want to understand the full process of fighting a rejected claim, here’s how it works.
Life Insurance: 17,237 Families Had to Fight
In FY 2024-25, 17,237 complaints were filed against life insurers at the ombudsman’s offices. Each complaint is a family that was denied, delayed, or shortchanged on a claim they believed they were owed.
Here are the top 5 life insurers by complaints received:
| Insurer | Complaints | Share of Total |
|---|---|---|
| Bharti AXA Life | 2,770 | 16% |
| LIC | 1,951 | 11% |
| HDFC Life | 1,320 | 8% |
| PNB MetLife | 1,060 | 6% |
| Bajaj Allianz Life | 998 | 6% |
Bharti AXA Life accounts for 1 in 6 of all life insurance complaints.
But raw complaint counts don’t tell the whole story. LIC has the largest policyholder base in the country by a massive margin. 1,951 complaints against a base of hundreds of millions of policies is a very different picture than 2,770 complaints against a much smaller book.
The question isn’t “who got the most complaints?” It’s “if I have this insurer’s policy, how likely is my family to end up in a fight?”
For the other side of this picture, how often insurers actually pay claims, check the claim settlement ratios.
When Families Won: Life Insurance Awards
Not every complaint ends in disappointment. When the ombudsman rules in the policyholder’s favor, it issues an “award,” a binding order for the insurer to pay up.
Here are the top 5 life insurers by awards against them:
| Insurer | Awards (in Family’s Favor) | Amount Awarded |
|---|---|---|
| Bharti AXA Life | 1,727 | ₹9.04 crore |
| HDFC Life | 640 | ₹13.71 crore |
| LIC | 558 | ₹8.55 crore |
| PNB MetLife | 554 | ₹10.22 crore |
| Bajaj Allianz Life | 530 | ₹5.54 crore |
Bharti AXA Life had the most awards by far: 1,727 out of 2,770 complaints. That’s a 62% win rate for families. In other words, 62% of the time a family dragged Bharti AXA to the ombudsman, the ombudsman agreed with the family.
HDFC Life had fewer cases but the highest payout: ₹13.71 crore. That suggests high-value claims being rejected. When an insurer denies a large claim and the ombudsman overturns it, the awarded amount is bigger.
Every row in that table is families who were told “no” and had to fight for months to get money that should have been paid. ₹9.04 crore from Bharti AXA alone, money that families had to go to a government body to receive.
Still Waiting: Unresolved Life Complaints
Some complaints don’t get resolved within the financial year. They carry over, unresolved, into the next year.
As of 31 March 2025, here’s who had the most outstanding life insurance complaints:
| Insurer | Unresolved Complaints |
|---|---|
| Bharti AXA Life | 503 |
| LIC | 184 |
| IndiaFirst Life | 169 |
| Bajaj Allianz Life | 151 |
| Reliance Nippon Life | 103 |
503 families with Bharti AXA Life policies are in limbo. Neither paid nor finally rejected. Just waiting.
The Mis-Selling Problem
One trend in the CIO report deserves its own mention: mis-selling complaints rose 14% year-on-year, from 23,335 to 26,667.
Agents selling ULIPs as “guaranteed returns.” Endowment plans pitched as “better than FDs.” Riders added without the policyholder’s knowledge. Policies sold by phone where the customer didn’t understand what they signed up for.
Mis-sold policies create a time bomb. The family discovers years later that the policy doesn’t cover what they thought it covered. The agent is long gone. The insurer points to the signed proposal form.
Buying the right policy matters more than buying the cheapest one. If you’re shopping for term insurance, here’s what to actually compare.
Health Insurance: Who Got the Most Complaints
Life insurance complaints happen after a death. Health insurance complaints happen while someone is in a hospital bed. Every day of delay means out-of-pocket bills piling up. And the numbers here are bigger.
| Insurer | Complaints |
|---|---|
| Star Health | 10,357 |
| Care Health | 3,836 |
| Niva Bupa | 3,696 |
| Aditya Birla Health | 2,166 |
| National Insurance | 1,608 |
Star Health: 10,357 complaints. More than the next three combined.
Star Health is the largest standalone health insurer in India, covering 23.78 million lives. So volume partly explains the number. But “partly” is doing heavy lifting in that sentence.
Normalized for size: Star Health had roughly 51 complaints per 1,00,000 policyholders. Compare that to Care Health, which covers 25.5 million lives but had 3,836 complaints, about 15 per lakh. Both are large insurers. One has more than three times the complaint rate of the other.
Size explains volume. It doesn’t explain the per-capita rate.
If your family has a health insurance policy, knowing what to do when a claim is denied or delayed can save lakhs. Here’s the family claim guide.
When Families Won: Health Insurance Awards
| Insurer | Awards (in Family’s Favor) | Amount Awarded |
|---|---|---|
| Star Health | 5,881 | ₹52.45 crore |
| Niva Bupa | 1,805 | ₹23.77 crore |
| Care Health | 1,700 | ₹18.33 crore |
| Aditya Birla Health | 1,266 | ₹12.57 crore |
| National Insurance | 803 | ₹4.66 crore |
Across all health insurers, 41% of complaints were resolved in the family’s favor. That’s according to the CIO’s own numbers, corroborated by CafeMutual’s analysis.
Star Health’s win rate for families: 57%. Out of 10,357 complaints, the ombudsman ruled in favor of the policyholder 5,881 times.
₹52.45 crore from Star Health alone. That’s money that should have been paid without a fight. Families who were sick, hospitalized, or recovering, and had to spend months dealing with the ombudsman process on top of everything else.
And these are only the families who knew the ombudsman existed, had the energy to file a complaint, and followed through. How many families gave up before reaching this stage?
Still Waiting: Unresolved Health Complaints
| Insurer | Unresolved Complaints |
|---|---|
| Star Health | 2,326 |
| Care Health | 1,190 |
| Niva Bupa | 786 |
| New India Assurance | 522 |
| Oriental Insurance | 385 |
| National Insurance | 357 |
A health insurance complaint isn’t abstract. It usually means someone paid ₹3-5 lakh out of pocket for a hospital bill and is waiting for the insurer to reimburse them. 2,326 families with Star Health policies are in that queue right now.
What This Means for Your Family
Your insurer’s track record matters more than the premium.
A cheap policy from an insurer that fights every claim isn’t actually cheap. The premium is just the sticker price. The real cost includes: will they pay when it matters?
Before buying, check complaint data alongside claim settlement ratios. An insurer with a 99% claim ratio but thousands of ombudsman complaints is telling you two different stories.
Your family won’t know how to fight.
You understand your policy. You know the claim process. Your family doesn’t.
If you die and the claim gets rejected, your spouse or parents are dealing with grief, paperwork, and an insurer’s legal team. They won’t know about the ombudsman. They won’t know there’s a free process to challenge the rejection. They’ll assume the insurer’s “no” is final.
Add the claim process somewhere they can find it. Show them how to fight a rejected claim. Make it so they don’t have to figure it out from scratch.
The real risk isn’t dying without insurance. It’s dying with insurance your family can’t use.
You have a policy. Good. But does your family know it exists? Do they know the policy number, the insurer’s name, the nominee details? Do they know where the documents are?
If they don’t, then when something happens, your family joins the statistic. Not the “claim rejected” statistic, but the worse one: the “never claimed” statistic.
The ombudsman data only counts families who fought. It doesn’t count the ones who gave up or never started.
If you have health insurance and you’re the policyholder, your family needs to know what happens to the policy when you’re gone. If your family is on a floater plan, they need to know whether coverage continues or vanishes.
Your insurer might pay. Or your family might end up in the ombudsman’s queue. Either way, the first step is the same: your family needs to know what policies you have, where the documents are, and what to do if something goes wrong. Anshin is an app where you add everything your family would need if you’re not around. Not just insurance, but locker keys, recurring payments, your child’s school, pending legal matters. No passwords. Just directions, so nobody’s starting from zero.
Disclaimer: This article is for informational and educational purposes only. It does not constitute legal, financial, or insurance advice. Data cited is from the Council for Insurance Ombudsmen (CIO) Annual Report 2024-25. Complaint counts and award amounts are as reported by CIO. Insurer performance should not be evaluated solely on ombudsman data. Consult a qualified professional for advice specific to your situation. Anshin is not a financial advisory service.