My insurance claim was rejected — how do I fight it?
If your insurance claim is rejected, get the written repudiation letter and policy wording, complain to the insurer's Grievance Redressal Officer, then escalate to IRDAI's Bima Bharosa portal and, if still unresolved, to the free Insurance Ombudsman.
Any policyholder or nominee whose health, life, motor, or general insurance claim has been rejected or short-paid by the insurer.
A situation like yours
Sunita's health insurer rejected her hospitalisation claim, citing a 'pre-existing condition.' She first asked for the written repudiation letter and read it against her policy wording, which actually covered her after the waiting period was over.
She complained to the insurer's Grievance Redressal Officer with the policy clause highlighted. When there was no real fix in 15 days, she filed on the IRDAI Bima Bharosa portal and then approached the Insurance Ombudsman, which heard her free of cost and directed the insurer to pay.
Representative example based on common cases — not a specific individual.
How to resolve it
- 1
Get the written repudiation letter and policy wording
Insurer (claims department)In person / by postAllow ~7 daysInsurers must give written reasons for rejecting (repudiating) a claim. Ask for the repudiation letter in writing and read it carefully against your full policy wording and terms. Often the cited reason does not actually match a clause — that mismatch is the core of your case.
- 2
Complain to the insurer's Grievance Redressal Officer (GRO)
Grievance Redressal Officer (insurer)OnlineAllow ~15 daysFile a written complaint with the insurer's Grievance Redressal Officer, quoting your policy number, the claim number, the repudiation reason, and the exact clause that supports you. Keep the complaint reference number. The insurer is required to address grievances within a defined timeline.
- 3
Escalate to IRDAI via Bima Bharosa
IRDAI (Bima Bharosa)OnlineAllow ~15 daysIf unresolved in about 15 days, escalate to the regulator. Lodge your complaint on the IRDAI Bima Bharosa portal (bimabharosa.irdai.gov.in) or call the grievance call centre on 155255. IRDAI takes the complaint up with the insurer and tracks it to closure.
- 4
Approach the Insurance Ombudsman
Insurance OmbudsmanFile an appealAllow ~30 daysIf it is still unresolved, approach the Insurance Ombudsman for your region (cioins.co.in) free of cost, within the time and value limits of the scheme. The Ombudsman can hear the dispute and pass a binding award directing the insurer to settle.
- 5
Consider the consumer commission (e-Daakhil)
District/State Consumer Disputes Redressal CommissionFile an appealAllow ~30 daysFor deficiency of service, you can instead (or additionally) file a consumer complaint online via e-Daakhil at the District/State Consumer Commission. This is an alternative legal route and can award the claim amount plus compensation; choose it if the Ombudsman route doesn't fit your case.
Your legal rights
IRDAI (Protection of Policyholders' Interests) Regulations — Insurance Regulatory and Development Authority of India
IRDAI regulates insurers' grievance handling and protects policyholders; a rejected claim must be backed by written reasons and you can escalate an unresolved grievance to the regulator.
Source: IRDAI, Government of India ↗Insurance Ombudsman Rules, 2017 (Redressal of Public Grievances)
The Insurance Ombudsman provides a free, out-of-court forum to resolve disputes against insurers, including wrongful claim repudiation, subject to the scheme's value and time limits.
Source: Council for Insurance Ombudsmen ↗Tools that help
Common questions
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