My health insurance claim was rejected. What do I do?
Complain to the insurer in writing first, by email or through its website. You can also register the complaint on Bima Bharosa, IRDAI's complaint portal. The insurer must acknowledge the complaint at once and resolve it within 14 days (IRDAI Master Circular of 5 September 2024). If it does not accept the complaint, it must give reasons tied to the policy terms.
If the insurer rejects the complaint, sends a reply that leaves you unhappy or says nothing for a month, you can take it to the Insurance Ombudsman. The ombudsman is free and online, covers claims up to ₹50 lakh, and takes complaints filed within one year of that point. A consumer commission is the other route, with its own two-year limit. The ombudsman will not take a matter a consumer forum already has.
Insurers have deadlines of their own. Cashless authorisation is due within one hour of the hospital's request. A claim that is not cashless is settled within 15 days of submission, and a late settlement carries interest at the bank rate plus 2%. No claim may be rejected or closed for want of documents.
The claim-rejected tool takes where your complaint stands. It returns the next step, the date the insurer must answer by, when the ombudsman opens and the last day to file there.
If this is where you are
The insurer rejected my claim and quoted a clause. I need to answer it in writing before I can go to the ombudsman.
Appeal letter against a rejected insurance 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.
₹299₹499
Launch price until 30 November
Common questions
How long does the insurer have to reply to my complaint?
14 days. If it cannot resolve the complaint, it must tell you within those 14 days about the Insurance Ombudsman and the consumer court.
When does the one year for the ombudsman start?
It runs from the insurer's reply to your complaint, or from one month after you sent it if there is no reply. The original claim rejection does not start it.
Can an insurer contest my claim after years of cover?
After 60 months of continuous cover a health claim cannot be contested for non-disclosure or misrepresentation, except for established fraud.
Does the tool tell me whether the rejection was right?
No. It works out the step you are at and your dates. It does not judge the insurer's reason for rejecting the claim.
Want this handled for you? Tell us where you stand and we prepare the papers and take you through the filing.