Insurance companies often reject valid claims citing vague policy exclusions, procedural lapses, or incorrect interpretation of terms. Our claims team thoroughly reviews your denial letter, policy wording, and claim history to identify solid grounds for appeal. We draft strong representation letters, escalate to IRDAI, and if needed, file complaints with the Insurance Ombudsman or Consumer Court.
Practical guidance for common insurance questions
First, obtain the insurer's written rejection or repudiation reason and identify the policy clause relied upon. Compare that reason with your policy wording and claim documents. If you believe the decision is incorrect, submit a written representation with supporting evidence and use the insurer's grievance process before considering further escalation.
A rejected claim may be challengeable when the insurer has incorrectly applied the policy terms, overlooked relevant evidence, or relied on facts that can be disputed. The strength of a challenge depends on the policy wording, the rejection reason, and the documents supporting the claim.
Keep the policy schedule and wording, claim form, rejection or repudiation letter, medical or repair records where relevant, bills and receipts, photographs, correspondence with the insurer or TPA, and any other evidence submitted with the claim. Keeping a dated record of communications can also help when escalating a dispute.
Review denial letter & policy documents
Identify valid grounds for appeal
Draft claims representation to insurer
Escalate to IRDAI Grievance Cell
File Ombudsman complaint if unresolved
Litigate in Consumer Court if required
Common questions about claim rejection
The most common reasons include: non-disclosure of pre-existing conditions, policy lapse due to non-payment, claim falling under exclusions, delayed intimation beyond 7 days, and insufficient documentation. Many of these are challengeable.
You can approach the Insurance Ombudsman within 1 year of the insurer's final rejection letter. For Consumer Court, the limitation is 2 years. We can also explore condonation of delay in exceptional circumstances.
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