My insurance claim was rejected unfairly. What can I do?
Simple answer
Complain in writing to the insurer first. If it rejects you, or doesn't reply within a month, you can go to the Insurance Ombudsman free of cost within one year (for claims up to ₹50 lakh), or file a case in the Consumer Commission.
Real-life examples
Rahul's health claim was rejected as a 'pre-existing disease', though he had declared his diabetes in the proposal form. He wrote to the insurer's grievance cell. A month later, with no fair answer, he filed a free complaint with the Insurance Ombudsman online.
Fatima's husband died when his life policy was five years old. The insurer tried to reject the claim over an old non-disclosure. After three years, the law does not allow a life policy to be questioned on any ground.
Joseph had already filed a consumer case over his car insurance claim, and then tried the Ombudsman too. The Ombudsman cannot take a matter already pending before a court or consumer commission.
What should you do?
- 1Ask for the rejection reason in writing. Collect the policy, claim form, bills, reports and all letters.
- 2Send a written complaint to the insurer's grievance officer by email or online. Keep the complaint number.
- 3If it is not resolved, escalate it on IRDAI's Bima Bharosa portal.
- 4If rejected, unhappy with the reply, or no reply in one month, complain to the Insurance Ombudsman within one year. It is free and can be filed online.
- 5For bigger claims, or if you prefer, file on e-Jagriti instead. For large amounts, talk to a lawyer first.
Exceptions & limits
- The Ombudsman cannot award more than ₹50 lakh. Bigger claims go to the Consumer Commission or court.
- The Ombudsman cannot hear a matter already pending or decided in a court, consumer commission or arbitration.
- Ombudsman rules cover personal, group, sole proprietor and micro enterprise policies. Other business policies may fall outside.
Official legal reference
Insurance Ombudsman Rules, 2017 — Rule 13(1)
The Ombudsman hears complaints on claim delays, full or partial rejection, premium disputes, misrepresented terms and policy servicing.
Insurance Ombudsman Rules, 2017 — Rule 14(3), 14(5)
Complain to the insurer first; go to the Ombudsman if rejected, unhappy or unanswered for a month, within one year; not if pending elsewhere.
Insurance Ombudsman Rules, 2017 — Rule 17
Award within 3 months of receiving all papers, capped at ₹50 lakh; insurer must comply within 30 days; binding on the insurer.
Insurance Act, 1938 — Section 45
A life policy cannot be questioned on any ground after three years from the policy, risk start, revival or rider date, whichever is later.
Consumer Protection Act, 2019 — Section 2(42)
'Service' includes insurance and banking, so a policyholder can also approach the Consumer Commission.
Where to get help
IRDAI Bima Bharosa
Escalate insurance complaints that the insurer hasn't resolved.
e-Jagriti (Consumer Commission e-filing)
File a case before the District, State or National Consumer Commission online.
Source & status
- Applies to
- All of India
- Law in force since
- 27 Apr 2017
- Legal review
- Draft — awaiting lawyer review
Educational information, not legal advice for your case. Exact facts and the law that applies matter — speak to a lawyer before acting.