Insurance Ombudsman Complaint Stuck in Process – What to Do When Your Partial Health Claim Isn't Moving

Kavita Reddy, a software professional based in Pune, had undergone a planned orthopaedic procedure at a reputed hospital in Koregaon Park in early February 2025. Her health insurer, New India Assurance, settled only a portion of her hospitalisation claim — leaving nearly 40% unpaid, citing reasons she found vague and procedurally questionable. She filed a complaint through the IRDAI Bima Bharosa portal in late February 2025, and for over three weeks the status read nothing more than "under verification." No acknowledgement. No hearing date. Nothing.

Kavita had already sent two follow-up emails to the regional Ombudsman office in Pune and had even re-raised the grievance on the IRDAI portal independently. Neither step moved the needle. A colleague suggested she speak to Advocate Sudhir Rao, who regularly handles insurance disputes and Ombudsman proceedings. The difference in approach was immediate. Specific procedural pressure was applied — a formal written escalation citing the Insurance Ombudsman Rules, 2017, along with a concurrent notice to IRDAI's Grievance Redressal Officer under Regulation 14 of the IRDAI (Protection of Policyholders' Interests) Regulations, 2017. Within ten days, the complaint was formally registered, a hearing date was fixed, and the Ombudsman eventually directed New India Assurance to settle the remaining claim amount with interest. What weeks of self-follow-up couldn't achieve, a structured and domain-specific legal approach resolved relatively quickly.

You can read about this case in detail at https://sudhirrao.com/insurance-ombudsman-complaint-stuck-partial-health-claim-ird/