Mera insurance claim galat tareeke se reject ho gaya. Main kya karun?
Simple answer
Pehle insurance company ko written complaint karo. Agar woh mana kare ya ek mahine mein reply na de, toh ek saal ke andar Insurance Ombudsman ke paas free mein ja sakte ho (₹50 lakh tak ke claim), ya Consumer Commission mein case kar sakte ho.
Real-life examples
Rahul ka health claim 'pre-existing disease' bol kar reject hua, jabki usne proposal form mein diabetes batayi thi. Usne insurer ke grievance cell ko likha. Ek mahine tak theek reply na milne par usne Insurance Ombudsman ke paas online free complaint ki.
Fatima ke pati ki death ke time unki life policy paanch saal purani thi. Company ne purani non-disclosure ka bahana bana kar claim rokna chaha. Teen saal ke baad kanoon kisi bhi ground par life policy par sawaal uthane nahi deta.
Joseph ne car insurance claim par pehle hi consumer case kar diya tha, phir Ombudsman ke paas bhi gaya. Jo matter court ya consumer commission mein pending ho, use Insurance Ombudsman nahi sun sakta.
Aapko kya karna chahiye?
- 1Reject hone ki wajah likh kar maango. Policy, claim form, bills, reports aur saare letters collect karo.
- 2Insurer ke grievance officer ko email ya online written complaint bhejo. Complaint number sambhaal ke rakho.
- 3Solve na ho toh IRDAI ke Bima Bharosa portal par complaint escalate karo.
- 4Reject ho, reply se khush na ho ya ek mahine mein reply na aaye, toh ek saal ke andar Insurance Ombudsman ko complaint karo. Ye free hai aur online ho sakti hai.
- 5Bade claim ke liye, ya aap chaho toh, e-Jagriti par consumer case karo. Badi amount ho toh pehle lawyer se baat karo.
Exceptions aur zaroori baatein
- Insurance Ombudsman ₹50 lakh se zyada nahi dila sakta. Usse bade claim Consumer Commission ya court mein jaate hain.
- Jo matter court, consumer commission ya arbitration mein pending ho ya decide ho chuka ho, use Ombudsman nahi sunta.
- Ombudsman rules personal, group, sole proprietor aur micro enterprise policies par lagu hain. Doosri business policies bahar ho sakti hain.
Official legal reference
Insurance Ombudsman Rules, 2017 — Rule 13(1)
Ombudsman claim delay, full ya partial rejection, premium dispute, galat terms aur policy servicing ki complaints sunta hai.
Insurance Ombudsman Rules, 2017 — Rule 14(3), 14(5)
Pehle insurer ko complaint; reject, naraazgi ya mahine bhar reply na aane par ek saal mein Ombudsman; kahin aur case pending ho toh nahi.
Insurance Ombudsman Rules, 2017 — Rule 17
Saare papers milne ke 3 mahine mein award, ₹50 lakh tak; insurer ko 30 din mein comply karna hoga; award insurer par binding.
Insurance Act, 1938 — Section 45
Policy, risk start, revival ya rider date (jo baad mein ho) se teen saal baad life policy par kisi bhi ground par sawaal nahi.
Consumer Protection Act, 2019 — Section 2(42)
'Service' mein insurance aur banking shamil hain, isliye policyholder Consumer Commission bhi ja sakta hai.
Help kahan milegi
Source aur status
- Kahan lagu
- Poore India mein
- Law lagu hua
- 27 Apr 2017
- Legal review
- Draft — lawyer review baaki hai
Yeh educational jaankari hai, aapke case ke liye legal advice nahi. Exact facts aur lagu law matter karte hain — kuch karne se pehle lawyer se baat karo.