The Union Finance Ministry on Monday tabled detailed data in the Lok Sabha revealing the scale of delays, grievance pendency, and regulatory violations in the health insurance sector following the implementation of the Insurance Regulatory and Development Authority of India’s (IRDAI) 2024 norms that mandate strict turnaround times for cashless claim approvals.
Responding to Starred Question No. 20, Finance Minister Nirmala Sitharaman presented a comprehensive statement outlining how insurers have adhered to the new deadlines—one hour for initial cashless authorisation and three hours for final discharge approval—effective from August 1, 2024.
Cashless Claim Timelines: Over 13% Cases Breach Initial 1-Hour Window
Data compiled by IRDAI for the period August 1, 2024 to May 31, 2025 shows that while a large majority of hospitals and insurers complied with the mandated timelines, significant delays persist.
- 86.88% of cashless pre-authorisation requests were approved within the required one hour.
- However, 13.12% of cases breached the timeline—
• 8.49% took between 1–2 hours,
• 3.11% took 2–5 hours, and
• 1.52% exceeded five hours.
For the final discharge authorisation, compliance appeared stronger:
- 96.69% were completed within the mandated three hours,
- While the remaining 3.31% spilled over, with 0.77% taking more than eight hours.
The figures highlight that while turnaround times have improved, thousands of patients continue to face hospital discharge delays due to prolonged insurer approvals.
Grievance Redressal: Insurers Miss Timelines in Thousands of Cases
The Minister also provided year-wise data on complaint handling under the Bima Bharosa platform, which is integrated with insurers’ internal Complaint Management Systems (CMS).
For FY 2024-25:
- 2,57,790 complaints were filed,
- 4,811 complaints—1.87%—remained unresolved beyond the stipulated 14-day window.
For FY 2025-26 (April–September 2025):
- 1,36,554 complaints were received,
- 532 cases breached the timeline, forming 0.39% of total complaints.
The Ministry clarified that the Bima Bharosa platform does not auto-escalate unresolved grievances to the Insurance Ombudsman. Dissatisfied policyholders must file a fresh complaint—physically or electronically—with the Ombudsman office having jurisdiction.
During FY 2024-25, a significant 53,102 complaints were lodged with Ombudsman offices, signalling persisting customer dissatisfaction with insurer responses.
Regulatory Violations: 11 Show Cause Notices Issued
Highlighting enforcement action, the Minister disclosed that eleven Show Cause Notices were issued in FY 2024-25 to insurance companies for violations related to policyholder rights and health insurance regulations. These included:
- Unnecessary claim deductions,
- Improper claim rejections,
- Other breaches of health insurance regulatory provisions.
Background: Why the IRDAI Timelines Matter
The IRDAI Master Circular on Health Insurance Business, issued on May 29, 2024, mandated insurers to overhaul internal systems to ensure faster cashless claim approvals. The norms were intended to reduce delays in hospital admissions and discharge—problems that had long plagued customers and often led to disputes between hospitals and insurers.
Insurers were granted time until July 31, 2024 to upgrade systems before the timelines became binding from August 1, 2024.
What the Numbers Indicate
The latest government disclosures show that while the industry has substantially adopted the new timelines, pockets of non-compliance continue to affect policyholders. The high volume of Ombudsman complaints further points to gaps in grievance resolution and customer satisfaction.
As regulators intensify oversight and insurers face increasing accountability, the government’s data offers both reassurance on progress made and a reminder of the reforms still needed to ensure a seamless cashless insurance experience for millions of Indians.
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