My Insurance Claim Was Rejected — What Should I Do?
A rejection isn't always final — here's how to understand why it happened and what you can do about it.
A claim rejection is stressful, especially during or after a medical or financial emergency — but it's not always the end of the road. Understanding exactly why a claim was rejected is the first step to knowing whether it's worth contesting.
Common reasons claims get rejected
- Non-disclosure of a pre-existing condition at the time of purchase.
- Claim falls within a waiting period that hadn't been completed yet.
- Missing or incomplete documentation submitted within the required timeline.
- The specific treatment or condition falls under a policy exclusion.
- Policy had lapsed due to a missed premium payment beyond the grace period.
Steps to take after a rejection
- Request the rejection letter in writing with the specific clause or reason cited — don't accept a verbal explanation alone.
- Re-check your policy document against the reason given — sometimes rejections cite a clause that doesn't actually apply to your situation.
- If you believe the rejection is incorrect, file a written complaint with the insurer's Grievance Redressal Officer.
- If unresolved after 30 days, escalate to the Insurance Ombudsman for your region — this is a free, formal dispute resolution channel.
- For IRDAI-regulated concerns, you can also file a complaint through the IRDAI's Integrated Grievance Management System (Bima Bharosa).
Do this — and avoid this
Do this
- Get the exact rejection reason in writing, referencing the specific policy clause.
- Escalate in writing (email) so there's a documented trail, not just phone calls.
- Use the Insurance Ombudsman for claims disputes up to ₹50 lakh — it's a free process.
Avoid this
- Giving up after the first rejection without understanding the actual cited reason.
- Missing the internal grievance escalation step before going to the Ombudsman — most processes expect this first.
- Assuming a rejection means fraud on your part — many rejections are honest documentation or interpretation issues.
Frequently asked questions
A free, government-backed dispute resolution mechanism for insurance complaints in India, available for individual policyholders with claims disputes typically up to ₹50 lakh, used after the insurer's internal grievance process is exhausted.
This varies, but it's best to escalate as soon as possible after receiving a written rejection — most insurer grievance processes and the Ombudsman have their own specific timelines, so don't delay.
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Need help with a specific claim?
Send us the details on WhatsApp — including any rejection letter — and we'll help you work out the next step.