Most Indians buy insurance with a simple expectation: pay premiums today and receive support when a crisis strikes.
But what happens when a claim gets delayed, partially settled, or rejected altogether?
In this episode of India FinTech Diaries, we speak with Shilpa Arora, Co-founder & COO of Insurance Samadhan, one of India’s largest insurance grievance redressal platforms.
Shilpa shares a sobering reality: for many policyholders, the real challenge isn’t buying insurance—it’s successfully navigating the claims process.
From mis-selling and hidden exclusions to complex grievance mechanisms and claim rejections, the conversation reveals why thousands of policyholders struggle to access benefits they believed they had already paid for.
Key themes from the episode
🚨 The Real Insurance Problem Begins at Claim Time
Most policyholders discover policy exclusions, waiting periods, room-rent caps, and coverage limitations only when they file a claim.
📚 Awareness Is the Biggest Gap
Many consumers don’t know about grievance officers, Bima Bharosa, insurance ombudsmen, or even the rights available to them under IRDAI regulations.
🎭 Mis-Selling Remains a Massive Challenge
Insurance products continue to be sold as fixed deposits, loan-linked products, or bonus schemes, leaving consumers trapped in policies they never intended to buy.
⚖️ Information Asymmetry Favors Insurers
Consumers often face experienced insurance teams while trying to navigate complex policy language and grievance processes on their own.
🤖 AI Is Entering Insurance Grievance Resolution
Insurance Samadhan is using RAG-based systems trained on thousands of historical cases to assess claims, identify winning arguments, and guide policyholders.
🏥 Insurance and Healthcare Are Deeply Interconnected
Claim disputes often originate from hospital billing practices, treatment protocols, and documentation issues—not just insurance policy wording.
🔮 Insurance Needs a Post-Sales Service Layer
The industry has invested heavily in distribution and sales, but far less in helping customers manage policies, file claims, and resolve disputes.
Timeline
00:00 Start
00:46 Introduction
01:45 About Shilpa
04:19 What’s broken in Insurance claims
09:45 Common issues with Insurance claims
17:49 Information asymmetry between insurer & insured
21:21 How Insurance Samadhan works
25:10 Business model of Insurance Samadhan
26:46 Tales from the front lines
29:20 Impact of regulations
33:31 The way ahead