The process, and where the figures come from
That drawer of repudiated claims.
Some of them are still in time.
Most hospitals have a drawer of repudiated cashless claims nobody escalated, because nobody was sure it was worth the afternoon. This page is what the published record actually says about that, and what the process involves. It does not rank insurers and it is not legal advice.
It costs nothing to file
There is no fee to approach an Insurance Ombudsman. No lawyer is required, and the process is designed to be used without one.
But there is a clock
A complaint must generally be made within one year of the insurer’s final reply. A claim sitting in a drawer for eighteen months is a claim that has usually run out of road.
You have to complain to the insurer first
The Ombudsman will ask what the insurer said when you raised it with them. A grievance reference, and their reply, is the thing most escalations are missing.
An award binds the insurer
If the Ombudsman awards in the complainant’s favour, the insurer is bound by it. The complainant is not — they can still go elsewhere afterwards.
There is a monetary ceiling
The Ombudsman handles complaints up to a prescribed limit. Above it, the forum is different. Check the current figure in the Rules before you spend the afternoon.
The patient usually has to be the complainant
It is their policy. A hospital can assemble the file, and generally does, but the complaint is made by the insured.
What the published figures do and do not say
The Council for Insurance Ombudsmen publishes complaint volumes and disposal figures every year, and IRDAI publishes claim settlement data. Both are on our claim data page, reproduced with the source named against each number.
A disposal is not a win
“Disposed of” includes complaints withdrawn, settled by agreement, dismissed and awarded. Reading a disposal rate as a success rate is the commonest mistake made with this data.
Volume is not quality
A large insurer generates more complaints than a small one because it writes more policies. That is why we publish counts with their denominators and refuse to turn them into a league table.
And nothing here predicts your claim
Whether yours succeeds depends on the policy wording, the clinical documentation and the reason given. An aggregate cannot tell you about one file.
What we can tell you about your own claims
The published data is about the industry. Your own settled claims are about you, and they are the ones worth reading.
Which deductions were never explained
A settlement advice that reduces a bill without giving a reason code, or gives one that does not match what was billed, is the clearest candidate for escalation.
Which were predictable
A room-cap proportionate deduction applied because the patient was admitted to the wrong category is not a dispute — it is a process to fix. Knowing which is which is the difference between escalating well and escalating everything.
And which are still in time
Sorted by how long is left on the clock, because the ones about to expire are the only ones where the afternoon is urgent.
Which Ombudsman office covers you.
There are seventeen Insurance Ombudsman offices and each has a defined territorial jurisdiction. Approaching the wrong one costs weeks, and the clock does not stop while you find out.
| Office | Broadly covers |
|---|---|
| Ahmedabad | Gujarat; Dadra and Nagar Haveli; Daman and Diu |
| Bengaluru | Karnataka |
| Bhopal | Madhya Pradesh; Chhattisgarh |
| Bhubaneswar | Odisha |
| Chandigarh | Punjab; Haryana (excluding some NCR districts); Himachal Pradesh; Jammu and Kashmir; Ladakh; Chandigarh |
| Chennai | Tamil Nadu (part); Puducherry (part) |
| Delhi | Delhi; Haryana (some NCR districts) |
| Guwahati | Assam; Meghalaya; Manipur; Mizoram; Nagaland; Tripura; Arunachal Pradesh |
| Hyderabad | Telangana; Andhra Pradesh; Yanam |
| Jaipur | Rajasthan |
| Kochi | Kerala; Lakshadweep; Mahe |
| Kolkata | West Bengal; Sikkim; Andaman and Nicobar Islands |
| Lucknow | Uttar Pradesh (part) |
| Mumbai | Goa; Mumbai Metropolitan Region |
| Noida | Uttarakhand; Uttar Pradesh (part); some NCR districts of Haryana |
| Patna | Bihar; Jharkhand |
| Pune | Maharashtra (excluding Mumbai Metropolitan Region); Goa (part) |
State level only. Several offices split a state by district — Maharashtra between Mumbai and Pune, Uttar Pradesh between Lucknow and Noida, Haryana between Chandigarh and Delhi. Before you file, confirm your district against the Council for Insurance Ombudsmen’s own list. We would rather tell you to check than be the reason a complaint went to the wrong desk.
Drapto is not an insurance intermediary, is not registered with IRDAI, and does not represent anybody in a dispute. This page describes a public process and points at the published sources. For the current time limits and monetary ceiling, read the Insurance Ombudsman Rules directly.
What runs without being asked
Improved most weeksA cancellation is offered to the next person in order, with a window, until somebody takes it.
Raised when the prescription is written, chased twice, then it stops. It does not nag.
An abnormal value escalates after thirty minutes if nobody named has acknowledged it.
Twenty-four rules, scored before submission and sorted by exposure rather than raw risk.
Ctrl-K from any screen. These are database queries, so they work offline and cost nothing.
Ask in your own words. Bring your own Anthropic or OpenAI key, or run Ollama on your hardware and nothing leaves the building.
We are deliberate about which is which. Most of what runs here is rules, not a model — because a rule is auditable, works when the connection drops, and cannot invent a figure. We build and improve both every week, and we will always tell you which one answered you.
Read the mechanism. Now check your own numbers.
Bring twenty settled claims, advices only, patient details redacted. We name the clause behind each reduction and you keep the findings.