What To Do If Your Insurance Claim Is Rejected

Here are a few of the possibilities:

Contact a grievance officer.

The policyholder should first contact the insurance company's grievance officer to learn why his or her claim was denied.

The policyholder can file a written complaint here, together with any supporting paperwork, and receive a written acknowledgement of the complaint with a date.

IRDAI should be contacted.

If the policyholder is not satisfied with the response to the grievance offer, he or she can contact the Insurance Regulatory and Development Authority of India (IRDAI) and file a complaint with the IRDAI Grievance Call Centre. You can also make a complaint through the IRDAI's consumer education website or the Integrated Grievance Management System, where you can track the progress of your complaint.

Go to the insurance ombudsman's website.

Finally, if the insurer's replies do not satisfy the policyholder, the policyholder can move to the Insurance Ombudsman or take legal action.

The insurance ombudsman plan, according to the IRDAI's consumer education website, was formed by the Indian government to allow individual policyholders to have their complaints resolved outside of the judicial system in a cost-effective, efficient, and unbiased manner. There are currently 17 insurance ombudsman in various locations, and any person who has a grievance against an insurer may file a written complaint with the insurance ombudsman whose territorial jurisdiction the branch or office of the insurer complained against or the complainant's residential address or place of residence is located, either directly or through legal heirs, nominees, or assignees.

The complaint must be made in writing on plain paper, duly signed by the complainant, and must include the complainant's name and address, the name of the insurer's branch or office against whom the complaint is being made, the facts giving rise to the complaint, any supporting documents, the nature and extent of the loss suffered by the complainant, and the relief sought from the insurance ombudsman.