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Insurance claim rejected, delayed or underpaid
Insurance disputes turn on the policy wording and the exact reason for rejection. Let's get both.
Answer a few questions and get your list →What the law says
Complain first to the insurer's grievance officer. If not resolved, you can approach the Insurance Ombudsman (free) or a consumer commission. IRDAI rules set timelines for claim decisions.
General information, not legal advice.
Papers that usually help
- Policy document with schedule, terms and all renewal certificates
The wording decides most disputes. - Proposal form (application) — ask the insurer for a copy
Central to non-disclosure rejections. - Rejection / settlement letter with reasons
What you must answer. - Claim form and acknowledgement with date
Answers "late claim" objections. - Discharge summary, hospital bills, prescriptions, test reports
Supports the claim amount. - Doctor's certificate on when the illness began
Answers pre-existing disease objections. - FIR/accident report, survey report, repair estimate and invoices, photos
Supports a motor claim. - Driving licence, RC and permit valid on the accident date
Answers licence objections. - Death certificate, medical records of last illness, nominee ID
Needed for life claims. - Grievance complaint and insurer's reply
Needed for Ombudsman. - File a written grievance with the insurer and keep the reference
First step before Ombudsman. - Renewal and portability records showing continuous cover
Limits non-disclosure rejections after long cover.
Questions Saboot will ask you
- What kind of insurance?
- What happened to the claim?
- What reason did they give?
- Have you complained to the insurer's grievance cell in writing?
- Did they reply within 30 days?
- How long have you held the policy continuously (including renewals/portability)?
- Did an agent or bank fill the proposal form for you?
Sources
Common situations
- Health insurance rejected my claim for a pre-existing disease
- Hospital says cashless not approved
- Insurer paid much less than my hospital bill
- Claim stuck for months with no decision
- Car insurance rejected because of driving licence
- Car stolen and insurer is delaying
- Life insurance claim rejected after a death
- Claim rejected because I told them late
- Insurer says the treatment is not “reasonable and customary”
- Crop or home insurance not paid after damage
- Policy cancelled or not renewed after I made a claim
- Tractor or farm equipment insurance claim rejected
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