Insurance Claim Rejected or Delayed? Your Complaint and Escalation Guide
Ask the insurer for the rejection reason in writing, send a written complaint to its Grievance Redressal Officer, and escalate to IRDAI’s Bima Bharosa if it is not resolved. IRDAI’s 2024 circular says insurers should resolve complaints within 14 days. If the insurer rejects your complaint or does not reply within 30 days, you can approach the Insurance Ombudsman, generally within one year.
The escalation ladder
| Level | Where | What to do |
|---|---|---|
| 1 | The insurer: branch or claims department | Raise a written complaint quoting the claim number |
| 2 | The insurer’s Grievance Redressal Officer (GRO) | Send a written grievance and take an acknowledgement |
| 3 | IRDAI Bima Bharosa | Register a complaint if the insurer does not resolve it in time or you are not satisfied |
| 4 | Insurance Ombudsman | For eligible cases, after the insurer has had a chance to respond |
| 5 | Consumer Commission or court | A legal remedy, depending on your case and legal advice |
The first 7 things to do
- Get the rejection or settlement letter in writing. Do not rely on a phone call.
- Ask for the exact policy clause the insurer relies on.
- Ask for the survey report or assessment details, where applicable.
- Ask for a breakup of every deduction.
- Collect your evidence: medical, repair or financial records.
- Send a written complaint to the insurer’s GRO.
- Keep the acknowledgement and reference number safe.
Common problems and the right response
| Problem | What to do |
|---|---|
| Claim rejected | Ask for the detailed reason and the policy clause in writing |
| Partial settlement | Ask for a deduction-wise calculation |
| Surveyor under-assessed the loss | Send your objection with supporting evidence |
| Claim pending | Ask in writing for the status and the exact pending requirements |
| Repeated document requests | Ask for one consolidated checklist |
| Wrong policy interpretation | Quote the relevant policy clause in your reply |
| Payment delay | Check the applicable timeline and your right to interest |
The timelines that apply
| Matter | Timeline |
|---|---|
| Cashless health authorisation | Decision within 1 hour; final authorisation within 3 hours of the discharge request |
| Health reimbursement | Within 15 days of submission |
| Death claim without investigation | Within 15 days of intimation |
| Death claim with investigation | Within 45 days of intimation |
| Insurer’s complaint resolution | Within 14 days |
| Waiting before the Ombudsman | Generally 30 days after your complaint to the insurer, if there is no reply |
| Time to approach the Ombudsman | Generally within one year of the insurer’s final reply or rejection |
Sources: IRDAI Master Circular on Health Insurance Business, 2024, and the IRDAI Master Circular on Protection of Policyholders’ Interests, 2024 (Ref. IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 September 2024). Timelines for other claims depend on the product and the survey process.
IRDAI Bima Bharosa
Bima Bharosa is IRDAI’s grievance portal. You can register a complaint, get a reference number and track it. IRDAI also has a call centre on 155255 or 1800 4254 732, and complaints can be emailed to complaints@irdai.gov.in. Register on the portal after you have complained to the insurer and not received a satisfactory resolution.
Insurance Ombudsman
The Insurance Ombudsman works under the Insurance Ombudsman Rules, 2017, and is run by the Council for Insurance Ombudsmen (cioins.co.in). It is free and you do not need a lawyer.
- Complain to the insurer first. You can go to the Ombudsman if the insurer rejects your complaint, does not reply within 30 days, or you are unhappy with its reply.
- Time limit. Generally within one year of the insurer’s rejection or final reply.
- Value limit. Claim value above a prescribed limit is not covered; the limit is ₹50 lakh under the rules as amended, so confirm the current figure on cioins.co.in before filing.
- Not in court. The same dispute should not be pending before a court or consumer commission.
- Award. If you accept the award, the insurer must comply within 30 days.
Find the Ombudsman office for your area and the complaint form on cioins.co.in.
A ready-to-use complaint letter
Subject: Complaint against rejection or short settlement of claim no. [number], policy no. [number]
Dear Sir or Madam,
My claim no. [number], dated [date], for [type of loss] under policy no. [number] was [rejected / settled for ₹___] on [date]. The reason given was [reason].
I disagree because [your points, with reference to the policy clause and your evidence]. I have enclosed [list of documents].
I request you to (1) give me the exact policy clause and the basis of your decision in writing, (2) share the survey or assessment report and a deduction-wise calculation, and (3) reconsider and settle the claim in full. As per IRDAI’s master circular, I expect a resolution within 14 days. If it is not resolved, I will approach IRDAI Bima Bharosa and the Insurance Ombudsman.
Yours faithfully,
[Name, address, phone, email]
What not to do
- Do not accept a verbal rejection as final.
- Do not sign blank discharge vouchers or declarations you have not read.
- Do not hide facts, even if you think they hurt your claim.
- Do not ignore the insurer’s letters. Reply in writing within the time given.
- Do not skip levels. The Ombudsman usually expects you to have approached the insurer first.
For product-wise help, see our health, motor and LIC claim guides.
Frequently asked questions
What should I do if my insurance claim is rejected?
Ask for the written reason with the exact policy clause, then send a written complaint to the insurer’s Grievance Redressal Officer. If it is not resolved, register a complaint on IRDAI’s Bima Bharosa or approach the Insurance Ombudsman.
How long does an insurer have to resolve a complaint?
IRDAI’s 2024 Master Circular on Protection of Policyholders’ Interests says insurers should resolve a complaint within 14 days.
When can I go to the Insurance Ombudsman?
After you have complained to the insurer and it has rejected the complaint, or has not replied within 30 days, or you are not satisfied with its reply. Generally you must file within one year.
Does the Insurance Ombudsman charge a fee?
No. The process is free and you do not need a lawyer.
Can I go to a consumer commission instead?
Yes, that is a separate legal route. The same dispute should not be pending before both the Ombudsman and a court or consumer commission, so take advice on which route to use.
Can the insurer reject my claim only because I informed it late?
IRDAI’s 2024 circular says no claim should be rejected or closed for want of documents or delayed intimation. If this is the stated reason, quote the circular in your complaint.
Need help with your claim?
Binod Kumar Shukla provides claim assistance: documents, coordination with the insurer, follow-up and escalation guidance. The insurer takes the final decision as per the policy terms.
Claim assistanceWhatsApp 9911581705Related guides
Sources: IRDAI Master Circular on Protection of Policyholders’ Interests, 2024 (Ref. IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 September 2024); IRDAI Master Circular on Health Insurance Business, 2024; Insurance Ombudsman Rules, 2017 (as amended); Council for Insurance Ombudsmen (cioins.co.in); IRDAI Bima Bharosa (bimabharosa.irdai.gov.in).
This guide is general information for policyholders and is not legal advice. Claim approval, amount and timeline depend on your policy terms, the facts of the loss and the insurer’s assessment; we cannot guarantee any claim outcome. Rules and limits change, so please confirm the current position with your insurer or the regulator. Insurance is the subject matter of solicitation. Binod Kumar Shukla is an IRDAI-certified Insurance Advisor and an agent of LIC of India, National Insurance Company and Niva Bupa, a Chief Life Insurance Advisor (CLIA) and LIC Chairman’s Club member, and an AMFI-registered Mutual Fund Distributor (ARN-50844, EUIN E053991). Claim assistance is provided for documentation, coordination and process guidance; it is not a guarantee of any claim outcome. Reviewed 7 November 2026.