The General Insurance Council (GIC), a statutory body under the Ministry of Finance, represents the interests of non-life insurance companies in India—including health, motor, fire, marine, and other segments. It works closely with the Insurance Regulatory and Development Authority of India (IRDAI) to support the growth and regulation of the general insurance industry.
In a welcome move, the General Insurance Council has launched a dispute resolution portal for hospitals to address long-pending grievances related to non-payment of cashless claims by insurance companies or TPAs, even in cases where such claims were duly authorized.
This mechanism has currently been introduced on a pilot basis in the states of Maharashtra, Tamil Nadu, and Karnataka, focusing on unresolved cases where hospitals have not received payments despite prior authorization of the cashless claim.
A committee will be constituted by GIC comprising representatives from insurance companies, TPAs, and hospitals to facilitate the resolution process.
GIC has shared the portal link for hospitals to raise disputes:
https://hospitaldisputeresolution.gicouncil.in/
Hospitals are required to register on the GIC website to access the portal. The dispute resolution process is divided into two categories:
Type A Disputes:
- These include cashless claims that have been duly authorized by the insurance company or TPA but have not yet been paid.
- The claim amount must be above ₹20,000.
- The grievance must have already been taken up through the insurance company’s grievance redressal mechanism.
- Such disputes must be raised within 120 days of authorization.
Type B Disputes:
- All other grievances fall under this category.
- GIC will escalate these issues to the concerned insurance company or TPA on behalf of the hospital.
- However, in Type B cases, GIC will not provide direct updates; the insurance company or TPA will be responsible for communication.
This initiative by GIC is a positive step towards resolving long-pending disputes where authorized payments have been delayed. Though currently limited to a few states, the portal is expected to expand nationwide and may eventually include other types of issues beyond claim payments.
GIC is also working on a Common Empanelment Project that aims to empanel hospitals at uniform rates applicable to all insurers. Presently, each insurer empanels hospitals independently at different rates, resulting in inconsistencies and confusion—especially when policyholders switch insurers and face unexpected issues with procedure costs.
The new dispute resolution portal should be seen as a logical extension of GIC’s broader goal to bring transparency, uniformity, and accountability in hospital-insurer relations.
