The grievance desk should be able to overrule the claims desk
Indian general insurers usually send a complaint about a claim back to the department that decided it. A grievance function without authority to revise decisions measures dissatisfaction instead of correcting it, and leaves the Insurance Ombudsman to do the insurer's work.
Taking the cashless decision back from three administrators
In 2021–22 every health claim Nilakhya received was processed by one of three third-party administrators, and a patient waiting for cashless approval waited a median of 3 hours 10 minutes.
NOTE II
Paying Chennai's flood claims before every survey was finished
In the first ten days of December 2023, after the cyclone rains that flooded Chennai, Nilakhya received 11,900 motor claims from the city, more than nine months of its ordinary volume.
A claim decision is finished only when the person who receives it can understand why, and could have predicted it from the policy they bought.
Gross direct premium, year to March 2026
₹9,420 Cr
Motor 38 per cent, health 34 per cent, crop 14 per cent, commercial lines 14 per cent
Median cashless decision, FY2025-26
41 min
Down from 3 hours 10 minutes in FY2021-22, after authorisation moved in-house
Grievances per 10,000 policies, FY2025-26
14
Down from 31 in FY2021-22, after the grievance panel could revise decisions
A policy is sold in minutes and kept over the days a claim takes, so I run an insurer's operations by the clock the policyholder is watching.
I am the chief operating officer of Nilakhya General Insurance Limited, a fictional Mumbai-headquartered general insurer listed on the NSE and BSE. In the year to March 2026 we wrote ₹9,420 crore of gross direct premium: 38 per cent from motor, 34 per cent from retail and group health, 14 per cent from crop insurance under the government scheme in three states, and the rest from property, engineering and marine cover for businesses. My responsibilities begin once a policy is issued. They cover claims in every line, policy servicing, our network of 12,600 hospitals and 5,200 garages, fraud investigation, grievance redressal and the contact centre.
I have spent twenty-seven years on the side of insurance that customers meet only when something has gone wrong. I began as an administrative officer in a public-sector insurer's divisional office in Visakhapatnam and later ran claims for a region from Bhubaneswar. I learnt health claims from the inside at a third-party administrator in Bengaluru, and catastrophe claims as a zonal head in Chennai when Cyclone Hudhud struck the city where I grew up. I joined Nilakhya as chief claims officer in 2016 and became its COO in April 2021.
The decisions I am proudest of made our operations more expensive before they made them better. We took cashless authorisation for retail health back from three administrators and built our own hub in Chennai. We gave our grievance team the authority to overturn the claims team. After the December 2023 floods in Chennai we paid motor claims on video surveys and audited them afterwards, accepting some overpayment in exchange for weeks of families' time. Each choice had serious opponents inside the company, and each is described on this site with its cost.
Cashless decisions in minutes, not hours
Since we moved retail health authorisation in-house, the median time to decide a cashless request has fallen from 3 hours 10 minutes in 2021–22 to 41 minutes in 2025–26, and the median discharge approval from 5 hours 40 minutes to 2 hours 5 minutes. Retail health retention rose from 77 to 84 per cent.
Complaints answered by people who can change the answer
Grievances fell from 31 to 14 per 10,000 policies between 2021–22 and 2025–26, and awards against us at the Insurance Ombudsman from 212 to 74 a year, after an independent review panel was given authority to revise claim decisions.
A flood surge settled in days
After the Chennai floods of December 2023 we settled 11,900 motor claims at a median of nine days, with 92 per cent paid within thirty. A post-payment audit of one claim in eight found overpayment on 2.6 per cent of those sampled.
Fraud tackled without abandoning patients
In 2024 we suspended cashless treatment at 37 hospitals in eastern Uttar Pradesh after billing analysis, honoured every admission already under way and reinstated 11 hospitals after hearings. Claims from the cluster fell from ₹96 crore to ₹51 crore a year.
Current focus
I am preparing the board's decision on whether to bring group health claims in-house as well, which would end our last administrator contract. Alongside it, I am redesigning crop-claims operations for the coming rabi season, as the states we serve combine crop-cutting experiments with technology-based yield estimates.
Conversations I welcome
I am not seeking to leave Nilakhya. I would consider one independent directorship at a listed company outside insurance with a large retail customer base, such as a lender or a regulated consumer-services business, joining its Risk Management Committee and, if the board wished, chairing its Stakeholders Relationship Committee. I can give about twenty-five days a year, subject to my board's consent and a conflicts review. I also accept a few invitations to speak to claims and operations audiences.
Beyond the page
The record behind the perspective.
Formation
Bachelor of Science (Statistics)Vedavalli College of Science · 1997
Master of Business AdministrationDhruvatara Institute of Management · 1999
Ananya brings our committee the measure that makes her own function look worse. When she put the slowest tenth beside the median, our figures deteriorated for two quarters, and we finally understood which patients we had been failing. I have rarely seen an executive ask to be judged more strictly.
Sharmila EkboteFictional independent director and chair of the policyholder protection committee, Nilakhya General Insurance LimitedThe full record ↗
Contact
I am not seeking to leave Nilakhya. I would consider one independent directorship at a listed company outside insurance with a large retail customer base, such as a lender or a regulated consumer-services business, joining its Risk Management Committee and, if the board wished, chairing its Stakeholders Relationship Committee. I can give about twenty-five days a year, subject to my board's consent and a conflicts review. I also accept a few invitations to speak to claims and operations audiences.
