Congress MP Shashi Tharoor has criticized the IRDAI for providing incomplete data on health insurance claim delays via the Bima Bharosa Portal. With health insurance accounting for 57% of pending grievances in FY 2025-26, the issue points to ongoing consumer challenges in the sector. Investors should watch for potential regulatory tightening that may impact operational costs for insurance firms.
Congress MP Shashi Tharoor has raised concerns regarding the transparency of data managed by the Insurance Regulatory and Development Authority of India (IRDAI) on the Bima Bharosa Portal. His critique centers on the lack of granular information regarding persistent delays in settling health insurance claims, which remains a primary pain point for consumers in the industry.
The Bima Bharosa Portal, the central mechanism for grievance redressal, recorded a total of 297,468 complaints during the 2025-26 fiscal year. While the majority of these were resolved, 9,972 cases remained pending as of the latest reporting period. Notably, health insurance claims dominated these unresolved cases, accounting for 5,664 complaints, or approximately 57% of the total pending grievances.
From a sector performance perspective, the grievance disposal rate for health insurance stands at around 95.2%. While this indicates a high resolution rate, it trails behind the 99.5% disposal rate observed in the life insurance segment. This gap suggests that health insurance claims—often complicated by medical documentation, co-payment clauses, and pre-existing condition requirements—remain more operationally challenging to process than other insurance products.
The government has previously attributed claim rejections or partial settlements to factors such as non-compliance with specific policy terms, the depletion of the sum insured, and instances where hospital stays were not deemed medically necessary. However, the current data provides little clarity on the specific bottlenecks causing settlement delays, which is the core issue that has drawn regulatory scrutiny.
For investors, these grievance figures serve as an important monitorable metric. High complaint volumes and ongoing consumer dissatisfaction often act as a precursor to stricter regulatory intervention. If the IRDAI decides to mandate more detailed disclosure or tighter timelines for claim resolution, insurance companies could face increased operational and compliance burdens. Any such move would likely force insurers to invest more in their claims processing infrastructure and customer service teams to maintain compliance and protect their market reputation. Investors may want to track upcoming IRDAI circulars or policy updates that might impose stricter reporting requirements on health insurers.