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Insurance Claim Rejected

Your health, life, vehicle, or general insurance claim has been rejected or delayed by the insurance company without valid reason.

Do this now
  1. 01Get the rejection letter with specific reasons from the insurance company
  2. 02Review your policy terms and conditions carefully
  3. 03Send a written representation to the insurance company's grievance cell
  4. 04File a complaint on IRDAI IGMS portal — igms.irda.gov.in
  5. 05Approach the Insurance Ombudsman within 1 year of rejection
  6. 06If Ombudsman does not resolve, file a case in Consumer Court
  7. 07Gather all policy documents, premium receipts, and claim correspondence
Evidence to collect
  1. Insurance policy document and terms
  2. Premium payment receipts
  3. Claim application and supporting documents submitted
  4. Rejection letter from insurance company
  5. All correspondence with the insurance company
  6. Medical bills and hospital records (for health claims)
  7. FIR copy (for vehicle theft or accident claims)
Documents you need
  1. Insurance policy document
  2. Claim rejection letter
  3. All claim-related documents submitted to insurer
  4. Premium payment proof
  5. Complaint to IRDAI IGMS
  6. Insurance Ombudsman complaint form
Where to complain
  1. Insurance Company Grievance Cell — First step
  2. IRDAI IGMS Portal — igms.irda.gov.in
  3. Insurance Ombudsman — Within 1 year of rejection
  4. District Consumer Forum — Claims up to Rs. 50 lakh
  5. State Consumer Commission — Claims Rs. 50 lakh-2 crore
  6. National Consumer Commission — Claims above Rs. 2 crore
Laws that apply
  1. Insurance Act — Section 45 (Policy not to be called in question after 3 years)
  2. IRDAI (Protection of Policyholders' Interests) Regulations
  3. Consumer Protection Act — Section 2(11) (Deficiency in service)
  4. Insurance Ombudsman Rules — For dispute resolution
  5. Motor Vehicles Act — Section 146 (Mandatory vehicle insurance)
Understanding the issue

Insurance companies in India are regulated by IRDAI (Insurance Regulatory and Development Authority of India). If your claim is wrongfully rejected, you can file a complaint with the Insurance Ombudsman, IRDAI Grievance Cell, or Consumer Court. Under Section 45 of the Insurance Act, policies cannot be questioned after 3 years on grounds of misstatement. Claim rejection must be communicated with clear reasons in writing.

When to see a lawyer

Consult a lawyer specializing in insurance law if the claim amount is large, if the Ombudsman's decision is unfavourable, or if you need to approach the Consumer Court.