Insurance Claim Rejected Without Valid Reason
Your insurance claim has been rejected or partially paid without a proper written explanation citing specific policy exclusions, or the rejection is based on a technical ground that was never communicated to you.
⚖️Your Rights Under RBI Regulations
Every claim rejection must be in writing, citing the specific policy clause or exclusion.
You have 30 days to appeal against a claim rejection.
Health insurers cannot reject cashless claims arbitrarily — they must communicate within specified timelines.
Repudiation on grounds of non-disclosure requires the insurer to prove you intentionally concealed material information.
💰 What You Can Recover
Full claim amount if rejection is unjustified. Compensation for mental agony and treatment cost at Consumer Forum.
⏱ Response Deadline
30 days to appeal with insurer. File with IRDA if still rejected.
📋Step-by-Step — What to Do
Request a detailed rejection letter citing specific policy clauses if not already received.
Write a formal appeal to the insurer's claims department within 30 days.
If claim exceeds Rs.20 lakh, approach the Insurance Ombudsman (ecoi.co.in).
File with IRDA at igms.irda.gov.in.
File at District Consumer Forum for claims below Rs.50 lakh.
🏛 Where to Escalate If Bank Doesn't Respond
Insurance Ombudsman (ecoi.co.in) + IRDA IGMS + District Consumer Forum
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