nsurance Claim Rejected? – Step-by-Step Guide to Get Justice
An insurance claim rejection occurs when an insurer refuses to approve a claim due to policy conditions, documentation issues, or non-disclosure. While claim rejection can be stressful, policyholders have legal rights and multiple remedies to challenge an unfair rejection.
This guide explains the step-by-step process to handle insurance claim rejection in India.
Common Reasons for Insurance Claim Rejection
Before taking action, understand why claims are rejected:
- Non-disclosure or incorrect disclosure of information
- Policy exclusions or waiting period not completed
- Delay in claim intimation
- Incomplete or incorrect documents
- Lapse in policy due to non-payment of premium
- Treatment or loss not covered under the policy
Step-by-Step Process to Claim After Insurance Rejection
Step 1: Read the Rejection Letter Carefully
- Check the exact reason mentioned for rejection
- Match it with policy terms and conditions
- Verify whether the rejection is valid or unjustified
Step 2: Review Policy Documents
- Policy wording
- Proposal form
- Benefit illustrations
- Endorsements (if any)
Many rejections occur due to misunderstanding of policy clauses.
Step 3: Collect Supporting Documents
Prepare all relevant documents such as:
- Policy copy
- Claim form
- Medical reports / bills / FIR (if applicable)
- Discharge summary
- Rejection letter from insurer
Step 4: Approach the Insurance Company (Grievance Cell)
- Write a formal grievance email or letter
- Attach all supporting documents
- Clearly explain why the rejection is incorrect
Insurers must respond within 15 days as per IRDAI guidelines.
Step 5: File Complaint on IRDAI Grievance Portal
If insurer response is unsatisfactory:
- File complaint on the IRDAI Integrated Grievance Management System (IGMS)
- Upload rejection letter and documents
- Track complaint status online
Step 6: Approach the Insurance Ombudsman
If the claim amount is within prescribed limits:
- File complaint with the Insurance Ombudsman
- No lawyer required
- Free and faster dispute resolution
Step 7: Legal Remedy (If Required)
As a last option:
- Approach consumer court
- Seek legal assistance
- File case under deficiency of service
Time Limit to Challenge Insurance Claim Rejection
- Insurer grievance: Immediately after rejection
- IRDAI complaint: After insurer response or non-response
- Ombudsman: Within 1 year of rejection
Timely action increases the chance of claim approval.
Tips to Avoid Insurance Claim Rejection
- Disclose complete and accurate information
- Read policy exclusions carefully
- Intimate claims on time
- Maintain all records and documents
- Renew policy before due date
Conclusion
An insurance claim rejection does not mean the end of the road. By following the step-by-step claim rejection process, understanding your rights, and using IRDAI and Ombudsman mechanisms, you can effectively challenge unfair rejections.
At Saving Mantra, we guide policyholders through claim rejection resolution, grievance filing, and documentation support, ensuring your rightful claim is not denied.
Disclaimer
This blog is for informational purposes only and does not constitute legal, financial, or insurance advice. Claim outcomes depend on policy terms, facts, and applicable IRDAI regulations. Readers are advised to consult qualified insurance professionals or legal experts for specific cases.