A rejected claim is not the final word. You can challenge it step by step – with the insurer, IRDAI, the Insurance Ombudsman (free) and the consumer commission.
Step 1: Get the reason in writing
The insurer must tell you why the claim was rejected, citing the policy clause. Common reasons: non-disclosure of an existing illness, waiting period, exclusions, late intimation, or missing documents.
Step 2: Complain to the insurer
- Write to the insurer’s grievance redressal officer with your policy number, claim number and why the rejection is wrong.
- Attach the policy, rejection letter, bills, discharge summary and doctor’s certificates.
- If unresolved, register on IRDAI’s Bima Bharosa portal.
Step 3: Insurance Ombudsman
- Free, no lawyer needed.
- Approach it if the insurer rejects your complaint, does not reply within 30 days, or you are unhappy with the reply.
- File within one year of the insurer’s reply.
- Covers claims up to ₹50 lakh. File online with the Council for Insurance Ombudsmen.
Step 4: Consumer commission
For larger claims, or if you prefer, file a consumer complaint for deficiency in service within 2 years. Find the right forum with the consumer commission finder.
Tip: for health policies, a claim cannot be challenged for non-disclosure after the moratorium period (5 years of continuous cover under current IRDAI rules), except for proven fraud.
This is general information, not legal advice. For more details, do consult a lawyer or a subject-matter expert about your own case.