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Appeal letter against a rejected insurance claim

How do I appeal when my insurance company rejects my claim?

A complaint letter to the insurer's grievance officer, with your policy clause and their reason set out, and a sheet with the dates that follow.

  • Complaint to the grievance officer
  • Before you send

₹299₹499

Launch price until 30 November. ₹499 after that.

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  • See the first page of your own document before you pay
  • Pay through Cashfree by UPI, card or netbanking
  • Word to edit and PDF to print, the moment the payment clears
  • Full refund if the documents are not delivered
  • Refund policy

You write to the insurer's grievance officer. The IRDAI Master Circular on Protection of Policyholders' Interests, 2024 (Part A, B or C, VI.2(i)) requires the insurer to resolve the complaint within 14 days. If it does not accept the complaint, it has to give reasons with specific reference to the relevant terms of the policy.

The letter also starts the clock for the next step. The Insurance Ombudsman Rules, 2017 need a written representation to the insurer first (rule 14(3)(a)). You can go to the ombudsman within one year of the insurer's reply, or once a month has passed with no reply. The ombudsman hears claims up to ₹50 lakh including expenses (rule 17(3)).

The letter quotes the policy wording the insurer relied on and the reason it gave, then answers it in your words. Where the ground is missing documents or late intimation, it cites the circular's rule that no claim is rejected or closed for want of documents or delayed intimation (V.1(ii)). For a health policy that ran for 60 months without a break, it cites the rule that non-disclosure cannot be used except for established fraud (Part B, IV.8).

The sheet that comes with it shows the date the insurer's 14 days end and the date the ombudsman route opens, counted from the day you send the letter.

Fill in your own

₹299₹499

Launch price until 30 November. ₹499 after that.

You

Your name *
Your address *
Mobile number
Email address
You are the *
Who holds the policy? *

The insurer and the policy

Insurer's name *
Grievance officer's address or email *The policy document or the insurer's website gives it.
Policy number *
Kind of policy *

The claim and the rejection

Claim number
Date the claim was made *
Amount claimed *
What did the insurer do? *
Date of the rejection letter *
Ground the insurer gave *
Reason in the rejection letter *Copy it as the letter states it.
Clause number the insurer relied onFor example "Clause 4.1(b)" or "Exclusion 3". Optional.
Wording of that clause *Copy it word for word from your policy document.
Why the rejection is wrong *Write one paragraph on each line. Stick to facts you can show.

Where things stand

Have you already written to the grievance officer about this rejection? *
If yes, the next step is the Insurance Ombudsman, and our ombudsman pack is built for it.
Has this claim ever gone to the Insurance Ombudsman, a court, a consumer forum or an arbitrator? *
Other documents you enclose
The policy, the claim papers and the rejection letter are listed already.
Date on the letter *Today, or any day in the next seven days.

We keep your answers and number so we can help if you ask. Ask us at any time and we delete them.

BuildWright does documentation, filing and compliance facilitation. This tool works from the rules cited on this page and does not give legal advice. We prepare the documents from your answers; you check, sign and send or file them.

Common questions

How long does the insurer have to reply?

The IRDAI Master Circular on Protection of Policyholders' Interests, 2024 requires resolution of the complaint within 14 days (VI.2(i)). If the insurer rejects the complaint, it has to give reasons tied to the policy terms.

Can an insurer reject a claim for late intimation or missing papers?

The Master Circular says no claim shall be rejected or closed for want of documents or for delayed intimation of claim (V.1(ii) of Parts A, B and C). The letter quotes it when the rejection rests on either ground.

What if I have already written to the grievance officer?

The pack is not built for that case. A second letter would blur the ombudsman's clock. The next step is the Insurance Ombudsman within one year of the insurer's reply, and we have a pack for that complaint.

Can I also use Bima Bharosa?

Yes. Bima Bharosa is IRDAI's complaint portal at bimabharosa.irdai.gov.in and it charges nothing. The letter is your written complaint to the insurer, and the portal is an additional place to register it.

Can I see the document before I pay?

Yes. Fill in your details and the page shows the first page of each document with your own answers in it. You pay only if it is what you need.

Can I change the document after I download it?

Yes. Each document comes as a Word file you can edit and a PDF you can print. You can also change your answers and prepare it again before you pay.

What if the payment goes through and the documents do not open?

The page checks the payment again and opens the documents on the same payment, so you are never charged twice. If they still do not arrive, write to us within 7 days and we refund the full amount.

Can you send or file it for me?

Yes. After you download, ask us to take the next step and we handle the sending or filing for you.

Not sure it applies to you?Check with the free Insurance Claim Rejected: What Next first. Nothing you enter is stored.

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Want this handled for you? Tell us where you stand and we prepare the documents and take the next step for you.