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Time of India
7 days ago
- Business
- Time of India
Rising insurance grievances push IRDAI to propose internal insurance ombudsmen—but will it stay neutral on insurer payroll?
To improve how insurance complaints are handled, IRDAI has suggested each insurer have an internal ombudsman. This aims to address the high number of unresolved grievances reported through the Bima Bharosa portal and the Council for Insurance Ombudsmen. The internal ombudsman will review complaints independently. This new role seeks to speed up resolution and provide an impartial review within the insurance company. Tired of too many ads? Remove Ads Tired of too many ads? Remove Ads What's the proposal? Tired of too many ads? Remove Ads What are the challenges? Where IRDAI proposal fits into the grievance redressal process In a bid to bolster the grievance redressal mechanism in the insurance sector, the Insurance Regulatory and Development Authority of India ( IRDAI ) has proposed the creation of internal insurance ombudsmen for all insurers. This is because, notwithstanding the perceived benefits of insurance, the industry is plagued by consumer to the annual report of IRDAI, its Bima Bharosa portal registered 2,15,569 grievances in 2023-24, while the Council for Insurance Ombudsmen (CIO) received 52,575 complaints in the same period. A recent study by Insurance Samadhan , a grievance redressal platform, states that nearly 88% of all complaints are related to claim the grievance redressal mechanism at various levels—insurers, IRDAI, and ombudsmen—addresses a large percentage of these complaints, many go unresolved. In 2024, there were 5,492 pending complaints on the Bima Bharosa portal and 7,202 with manage this burgeoning load of grievances, IRDAI has proposed another level of redressal—an independent ombudsman stationed internally with every insurer. 'The existing process is overloaded right now. In larger cities, it takes the external ombudsman body over six months to resolve complaints. Having an internal ombudsman should help speed up things and ensure there's a final, impartial review within the organisation itself,' says Shilpa Arora, COO & co-founder of Insurance Samadhan.'The internal ombudsman will function as a neutral, independent authority within the company, acting almost like a proxy for the regulator. It aligns with the broader regulatory shift towards principle-based management, where insurers are given more autonomy, but with clear responsibilities,' says Amit Chhabra, CBO, General Insurance, whether this initiative creates an effective redressal tool for consumers or stagnates as an academic exercise, or worse, is riddled with bias and prejudice, remains to be per the exposure draft of the IRDAI ( Internal Insurance Ombudsman ) Guidelines, 2025, released on 25 July this year, all insurers (except reinsurers) who have completed three years of operations will have to appoint an Internal Insurance Ombudsman (IIO). This will be in addition to the insurer's internal Grievance Redressal Unit and Grievance Redressal existing grievance redressal system is a five-step process (see graphic), wherein the aggrieved policyholder first needs to approach the insurer's grievance redressal cell and, if not satisfied, escalate it to the insurer's Grievance Redressal Officer. The next step is IRDAI's Grievance Redressal Cell, and if still unhappy, he can approach one of the 17 external Insurance Ombudsmen . The last option is legal recourse. IRDAI has now proposed an additional step before one contacts external redressal bodies—the internal ombudsman attached to the IIO should have at least 20 years' experience in the insurance industry, with a post not less than two levels below that of the director of a board. Importantly, the appointee should not have worked for or be employed by the insurer or any of its group companies at the time of appointment. The ombudsman will serve a fixed term of three years, with an extension of one more three-year term. More than one IIO can also be appointed, but the insurer will have to define the jurisdiction of IIO can address complaints for claims up to Rs.50 lakh that have not been responded to by the insurer within 30 days of receipt of the complaint or have been partly or wholly rejected. 'While the IIO will not have judicial or enforcement powers like a court, it has the power to independently review and advise on customer complaints that have been rejected or partially resolved by the insurer,' says Nazeem Khan, Head, ICLM & Motor Third Party Claims, ICICI Lombard.'The ombudsman can try to settle the matter through discussion. If it doesn't work, (s)he can give a final decision after hearing both sides. This decision will be binding on the insurer. It can include asking the company to pay a claim, refund a premium, or give compensation. The insurer must act on this within seven working days,' explains Anand Roy, MD & CEO, Star Health and Allied monitoring of internal ombudsman will happen at two levels. Internally, (s)he will report to the top leadership and, externally, IRDAI will review its functioning regularly.'CBO, GENERAL INSURANCE, POLICYBAZAARThe IIO shall report to the insurer's managing director/CEO administratively and to the Board/Policyholder Protection, Grievance Redressal, and Claims Monitoring Committee functionally. The remuneration will be fixed by the insurer board, which will also decide the annual increase. 'The monitoring of IIO will happen at two levels. Internally, (s)he will report directly to the top leadership, and externally, IRDAI will review its functioning regularly, especially if customer complaints remain unresolved despite the ombudsman's intervention,' says the benign intent and seemingly straightforward role of the IIO, the proposal could be marred by some being positioned as an independent authority, the fact that the IIO will be paid by the insurer and report to its leadership can foster prejudice and conflict of interest. 'One major concern is the potential lack of independence since the IIO is administratively linked to the insurer. There's also a risk that the role could become more symbolic than effective unless it's closely and consistently monitored,' says however, disagree. 'The ombudsman will be structurally independent, with no business or sales targets. Their tenure, seniority, and reporting lines ensure insulation from operational bias,' says Pahwa, Chief Compliance Officer, Future Generali India Life Insurance, agrees. 'Though the IIO will draw a salary from the insurance company, (s)he will not be motivated by any other factors like material or personal growth,' he up of pending grievances'We don't see any conflict since the IIO will report to the CEO and board committee that looks after customer interests, not the day-to-day management. Besides, the internal ombudsman cannot be someone who has worked with the insurer or its group companies,' adds it will help to be cautious. 'Having strong structural safeguards in place will be key to ensuring true neutrality. Mandating disclosure of complaint categories, decisions taken, any overrides, regular audits, and training sessions would be important to ensure that the IIO stays objective and consistent,' asserts the perception that internal grievance cells are biased towards the insurance companies, consumers may believe the same about IIOs since they will be paid by and report to the insurer. They may consider it an unnecessary, additional, cumbersome process before they approach the external ombudsman. Hence, there will be a greater need to clearly define the role and scope of the internal grievance cell and the internal ombudsman.'After the setting up of the internal ombudsman, it should be made mandatory for all dissatisfied customers to first exhaust the company's grievance redressal options before accessing external bodies like the insurance ombudsman or courts. A tracking system would be crucial for this approach to work,' says Roy.'One major concern is the potential lack of independence, since the IIO is administratively linked to the insurer. There's also a risk that the role could become symbolic.'COO & CO-FOUNDER, INSURANCE SAMADHANHowever, most experts agree that there may not be too many overlaps. 'Both the IIO and Grievance Redressal Officer play the same role in resolving customer complaints but will differ in authority, function, and placement in the grievance redressal hierarchy. The GRO reviews and monitors complaints within the company and provides solutions in line with the response/submission from the internal team or stakeholder, reviewer who takes his own decision without intervention of any internal team or stakeholder,' says Khan.'The IIO will come in only after the insurer's internal grievance process has been completed. It will act as the final layer of internal review. Since the IIO is expected to be independent in its judgement, it should complement the existing system, not conflict with it,' says time will tell if the internal ombudsman will be able to act as an independent and impartial functionary. The proposal is open to suggestions from all stakeholders till 17 August and will be implemented later this year after the regulator considers the the insurer's customer service or complaints/ grievance redressal there is no or inadequate response, escalate it to the insurance company's Grievance Redressal INTERNAL INSURANCE OMBUDSMANContact the IRDAI's Grievance Redressal Cell of the Policyholder's Protection & Grievance Redressal IRDAI's resolution is inadequate, approach the Council for Insurance dissatisfied with the resolution, approach the courts.
Economic Times
01-08-2025
- Business
- Economic Times
My wife and I have Rs 8 lakh base and Rs 7 lakh top-up health insurance cover, do I need more?
Getty Images Have a question for the experts? etwealth@ Our panel of experts will answer questions related to any aspect of personal finance. If you have a query, mail it to us right away. My wife (56) and I (61) are currently covered under a floater policy with Rs 8 lakh base cover and a Rs 7 lakh top-up. Do you suggest any changes in our existing coverage? Is it still possible to revise or enhance the policy at our age? We've had no claims since the policy was first taken over 15 years ago. Shilpa Arora General Manager, Co-founder and COO, Insurance Samadhan: It's commendable that you have maintained a claim-free health insurance record for over 15 years. It reflects well on your health and strengthens your profile with insurers. You currently have a health insurance coverage of Rs 15 lakh, including your top-up plan. At this stage, you may consider increasing your overall coverage to Rs 25-30 lakh, preferably by enhancing your top-up or opting for a super top-up with an appropriate deductible. That will ensure greater financial protection against high-value medical treatments. Additionally, it's important to review your policy for the following: l Room rent capping: If your policy limits room rent (say, 1% of sum insured), you could face out-of-pocket expenses for a higher category room. l Sub-limits on modern treatments: Check for caps or exclusions on advanced procedures like robotic surgeries, oral chemotherapy, intravitreal injections, or monoclonal antibody therapies. These treatments are becoming quite common, and sublimits can reduce the claimable amount. For instance, robotic-assisted knee replacements are now preferred for precision and recovery benefits. However, if your policy has caps on robotic surgery, you might have to bear a substantial portion of the expense yourself. So, depending on the features of your current plan, you can either continue with the same policy or explore portability within the same insurer to shift to a more comprehensive product. In any case, it is wise to proactively review and upgrade your health insurance, especially in your 60s, to stay prepared for evolving medical needs. My 26-year-old unmarried daughter wants to purchase medical insurance. She is healthy and has no pre-existing medical conditions. I would like you to suggest some tips so that she can choose the right policy. Sarbvir Singh Joint Group CEO, PB Fintech: It's great that your daughter is starting health insurance at 26 with no pre-existing conditions. She will get a broad coverage at a low premium. As a baseline, we recommend she consider a sum insured of at least Rs 20-25 lakh. She should opt for a plan that includes pre- and posthospitalisation expenses, daycare procedures, and ideally OPD and mental health coverage, which is now included in most policies. It's also important to choose a plan with no disease-specific or room rent sub-limits, and to avoid co-payment clauses, wherever possible. These often reduce claim payouts and result in unexpected out-of-pocket expenses. A short waiting period for pre-existing conditions is an added bonus, even if she doesn't need it now. She should look at the insurer's claim settlement ratio and ensure a wide network of cashless hospitals for ease during emergencies. A no-claim bonus feature, which increases her coverage each year she doesn't claim, will reward her for staying healthy. A well-chosen plan now can protect her for decades and even allow seamless upgrades later. Have a question for the experts? etwealth@ (Disclaimer: The opinions expressed in this column are that of the writer. The facts and opinions expressed here do not reflect the views of N.R. 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Mint
17-07-2025
- Health
- Mint
Does insurance cover weight-loss injections or bariatric surgery?
Obesity is no longer seen as a cosmetic issue — it's a chronic lifestyle disease linked to diabetes, hypertension, sleep apnea, and infertility. The Indian insurance industry has begun to recognize this shift. However, coverage still varies across types of treatment — bariatric surgery versus injections. The Insurance Regulatory and Development Authority of India (IRDAI) issued a landmark circular in October 2020 that made it mandatory for all health insurers to include coverage for medically necessary bariatric surgery under certain conditions. As per the guidelines: 'Bariatric surgery shall not be excluded when it is medically necessary and prescribed by a medical practitioner for treatment of obesity and co-morbid conditions.' BMI ≥ 40 (morbid obesity) without comorbidities, or BMI ≥ 35 with serious co-morbidities, such as type 2 diabetes, hypertension, obstructive sleep apnea and heart disease This move was a big shift, as earlier, most insurers treated bariatric surgery as a cosmetic or elective procedure. Now, if these medical thresholds are met, hospitalisation costs and surgery can be covered, subject to policy terms, waiting periods, and exclusions. In contrast, anti-obesity injections — such as GLP-1 receptor agonists like Semaglutide (Ozempic/Wegovy) and Liraglutide (Saxenda) — are still not universally covered. But, Ozempic (Semaglutide) is approved in India for Type 2 diabetes. If prescribed as part of diabetes management, it may be covered under policies that allow outpatient benefits or chronic care riders. Saxenda, which is approved abroad for weight loss but not yet widely approved for obesity in India, is typically not covered, especially for standalone weight loss. Most policies still exclude weight-loss medications under general exclusions unless they are part of the treatment of a covered illness. Review your policy documents for clauses around bariatric surgery and chronic condition riders. If you have Type 2 diabetes, PCOS, or cardiovascular risk, and have been prescribed GLP-1 injections, you may request pre-authorisation or medical necessity documentation and check The 2020 Irdai directive opened the door for medically necessary bariatric surgery, which is a big win for people with morbid obesity and related health issues. While insurance for obesity injections is still evolving, growing awareness and medical necessity documentation may improve chances of approval. Shilpa Arora is co-founder & COO at Insurance Samadhan.
NDTV
14-07-2025
- Health
- NDTV
Indian Declares Life Abroad Is Just "Surviving On Instant Noodles"
People living abroad or away from home know the struggle. No matter how exciting the place or how good the food, nothing hits quite like ghar ka khana. Simple dal-chawal, mom's sabzi, or just a cup of homemade chai somehow feels like a warm hug. No restaurant or frozen meal ever truly matches that comfort. But when you're drowning in work, classes, or just too tired, who's got the time to cook a proper desi meal? That's when the saviour shows up. Instant noodles. Quick, no-fuss, and ready in minutes. They have become the go-to for homesick students, young professionals, and anyone trying to survive abroad on a budget. A recent viral Reddit post by an Indian captured this reality perfectly. The post read, "Why does everyone back home assume that being an NRI means I'm rolling in money and living in some luxurious palace? I'm just here in a tiny apartment, surviving on instant noodles and pretending I know what 'adulting' means." Read the post here: by u/regoupe in nri Instant noodles may be the ultimate quick fix, comforting, easy, and budget-friendly, but they are not exactly the healthiest option out there. Nutritionist Shilpa Arora gave the classic Maggi noodles a healthier twist by adding masala tofu to boost its protein content. Maggi is often criticised for being high in sodium, low in nutrients, and packed with preservatives. Shilpa Arora's version swaps out the guilt by turning it into a more balanced meal, cooked in yellow butter for added flavour and enriched with plant-based protein. Read the recipe here. Nutritionist Mohita Mascarenhas believes that while Maggi is made with maida and low in nutrients, it can be made healthier with the right additions. She suggests boosting its nutritional value by adding fibre-rich veggies and protein sources like chicken, tofu, eggs, paneer, or soy granules. These ingredients not only balance out the carbs but also make the dish more filling and digestion-friendly. Read more here. 5 healthy ways to upgrade your instant noodles: Add veggies - Mix in spinach, carrots, peas, bell peppers, or any available vegetables to boost fibre and nutrients. Include protein - Add boiled eggs, grilled chicken, tofu, paneer, or soya chunks to make the meal more filling and balanced. Use less tastemaker - Reduce the seasoning packet and flavour with your own spices like garlic, chili flakes, turmeric, or a splash of soy sauce. Switch to better noodles - Opt for whole wheat, millet, or oats-based noodles instead of refined maida versions. Make it soupy - Add extra water and turn it into a broth-style bowl for a lighter, more hydrating meal.
NDTV
07-07-2025
- Health
- NDTV
How To Reduce Bloating And Belly Fat: This 5-Ingredient Morning Powder May Help
Waking up with a bloated belly, heartburn, or that sluggish-can't-move feeling? You are not alone. It is a common complaint, especially when the night before involved late meals, erratic digestion, or hormonal ups and downs. The discomfort can throw off your energy, mess with your appetite, and ruin your mood before the day has even begun. That is why many nutritionists suggest starting the day with simple, gut-friendly rituals, like this de-bloat powder made from ingredients you probably already have in your kitchen. Rooted in traditional wellness practices and backed by emerging science, this five-ingredient mix could ease bloating, support digestion, and even aid in inch loss. Here is what the science says, how to make it, and why starting your morning right could be the smartest thing you do for your gut health. Also Read: 5 Ways To Feel Easy After A Heavy Meal What Causes Bloating And Morning Gut Trouble? Bloating is not just about what you eat - it is often about how your gut is functioning. Food that lingers in the stomach too long, an imbalance in gut bacteria, or gas trapped during digestion can all lead to that puffed-up, heavy feeling. A review in The American Journal of Gastroenterology lists SIBO (small intestinal bacterial overgrowth), poor gut motility, and carbohydrate intolerance as common triggers. Meanwhile, Frontiers in Microbiology points to the importance of diverse gut flora in reducing bloating and improving metabolic health. When your microbiome is healthy, it can better absorb nutrients and reduce inflammation, both crucial for long-term weight management and energy regulation. Why Mornings Matter For Gut Health And Metabolism? How you start your day can shape your digestive rhythm for the hours that follow. Macrobiotic health coach and nutritionist Shilpa Arora says mornings are ideal for "capitalising on weight loss and metabolic activation". She advises drinking warm water first thing to gently cleanse the system and improve how nutrients are absorbed. Ayurvedic medicine has long supported this idea. According to its principles, lukewarm water helps preserve energy while stimulating digestion - a small but impactful morning habit. Also Read: Puffy Face, No More! 7 Smart Tricks To Avoid Bloating On Face De-Bloat Powder: The 5-Ingredient Recipe That Has Nutritionists Talking Dietician Aarzoo Sethi recently shared her version of a de-bloat powder that she says works well when paired with a calorie-deficient plan. According to her, those who try the mix can "lose up to 3 kilograms in just 7 days" while also easing digestive issues and reducing bloating. How To Make This Morning Gut Health Mix Take one cup each of cumin (jeera), fenugreek (methi), fennel (saunf), carom seeds (ajwain), and mustard seeds. Toast them lightly on a dry pan until aromatic. Let them cool, then grind into a fine powder. Mix one teaspoon in a glass of water and drink daily on an empty stomach. This simple blend can become part of a consistent morning routine aimed at improving digestive health, reducing puffiness, and supporting weight loss goals. Photo Credit: Pexels Why This Morning De-Bloat Mix May Help With Weight Loss? 1. Improves Digestion And Reduces Gas: Ajwain and fennel are known for their gas-relieving, antispasmodic properties. These herbs support smoother digestion and reduce symptoms like cramps and heaviness. Cumin helps stimulate digestive enzymes and bile, both of which enhance nutrient absorption and prevent sluggishness. 2. Helps Stabilise Blood Sugar: Fenugreek is rich in soluble fibre, which slows carbohydrate digestion and promotes satiety. Studies have shown that fenugreek can reduce cravings and help regulate appetite - both helpful when managing weight. 3. Boosts Metabolic Function: Mustard seeds are mildly thermogenic, meaning they help the body burn calories more efficiently. Their selenium and glucosinolate content also aids liver detoxification and supports a healthy metabolism. 4. Eases Water Retention And Inflammation: Each of these ingredients has natural anti-inflammatory and diuretic properties, which can help flush out excess water and ease bloating-related puffiness. Also Read: 7 Best Anti-Inflammatory Foods You Must Add to Your Diet Photo Credit: Pixabay Final Thoughts On Gut Health, Bloating And Daily Wellness While this de-bloat powder is not a magic solution, it can be a useful daily addition for those looking to support digestion and manage weight naturally. When combined with mindful eating, proper hydration, and regular movement, it may help reduce bloating and improve how your body feels - and functions - each day. Consistency is key. So is listening to your body. And sometimes, all it takes is a teaspoon of old-school wisdom mixed with modern science to start the day right. Advertisement About Somdatta Saha Explorer- this is what Somdatta likes to call herself. Be it in terms of food, people or places, all she craves for is to know the unknown. A simple aglio olio pasta or daal-chawal and a good movie can make her day. For the latest food news, health tips and recipes, like us on Facebook or follow us on Twitter and YouTube. Tags: De-bloat Powder Natural Remedy For Bloating Morning Digestion Tips Show full article Comments
