What to do if your insurance claim is deniedInsurance policies are bought to cover risks and to prepare for contingencies. When actually the risks are to be borne, you make a claim and your claim is rejected, it could be disheartening. You may think that it is totally unfair, especially when you have been paying your premiums on time every year. However, most insurers have a claim settlement ratio of more than 90%. The average rejection ratio is much less than 8%. If your claim is one of those that got rejected, is there anything that you can do? Here are the steps that you can take.

Assess The Reason

The first step is to find out why your claim got rejected in the first place. When an insurance company rejects a claim, it has to state the reasons why the claim was rejected. Compare the reasons for rejection with the terms and conditions stated in your policy. Are those a part of the exclusions in your policy? Was it rejected because you filed the claim late? If you find that the rejection was unfair and you were within your right to make the claim, then, you can go ahead and lodge a complaint.

Get the documents

You need a number of documents if you are going to lodge a complaint against the insurance company. You will need the copy of your insurance policy, the payment receipts for your premium, copies of bills if you are claiming reimbursement and the note the insurance company gave you with the reasons for rejection.  

Write a complaint to your insurance company along with the copies of the documents. The following documents might have to be submitted.

  •  Copy of your policy
  •  Copy of claim rejection given by the insurance company
  •  Copies of any letters or emails between you and the insurance company
  •  Copies of premium payment receipts
  •  Copies of the claim submitted by you
  •  Copy of id proof

If the insurance company doesn’t respond or fails to give you a satisfactory reply within a month of filing your complaint, you can go to the Insurance Regulatory and Development Authority of India (IRDA).

The IRDA has a dedicated call centre for addressing grievances. The call centre numbers are 1800-4254-732 or 155255. The timings of this call centre are from 8 AM to 8 PM on all days except Sunday. Once you register the complaint, you can track the status of the complaint online. If you want to email your complaint to IRDA, you can write a mail to complaints@irda.gov.in. If  IRDA doesn’t respond to your complaint within 15 days or if you think you have not got a positive response from IRDA, you can go to the Insurance Ombudsman.

The Insurance Ombudsman has been created by the Government of India to help policyholders to settle insurance complaints out of court and amicably. Insurance Ombudsmen has branches all over the country. You can write a complaint to the Insurance Ombudsman in the jurisdiction where the insurance company is registered.

Apart from claim denial, Insurance Ombudsman will also address delays in claim settlement, disputes regarding premium payments, non-issuance of policy documents and any other legal issues between you and the insurance company. The value of the claims, however, have to be less than Rs 20 lakh.

Usually, the Insurance Ombudsman settles cases within three months. It gives the insurance company about 15 days to settle the amount that the insurance company has to pay. You will have to give in writing that you have to accept the award that the Ombudsman is willing to grant. You will need to inform the insurance company about the complaint and the settlement that the Ombudsman has asked the insurance company to give.

Usually, IRDA is prompt in resolving insurance complaints where the policyholder has been treated unfairly. So, be clear in your complaint and provide the right documents and your claim might get settled.  

Staff Writer

This article is written by RupeeIQ editorial staff.