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Life insurance claim rejected after a death

What usually matters in this situation, and the papers to keep ready before you meet an advocate or free legal aid (call 15100).

Your situation

• What kind of insurance? Life / term
• What happened to the claim? Fully rejected

Papers to gather

• Policy document with schedule, terms and all renewal certificates
  The wording decides most disputes. Where: Insurer portal, email.
• Rejection / settlement letter with reasons
  What you must answer. Where: Email, letter.
• Claim form and acknowledgement with date
  Answers "late claim" objections. Where: Your records.
• Death certificate, medical records of last illness, nominee ID
  Needed for life claims. Where: Hospital, registrar.

You may also need, depending on your answers

• Proposal form (application) — ask the insurer for a copy — Central to non-disclosure rejections.
• Doctor's certificate on when the illness began — Answers pre-existing disease objections.
• Driving licence, RC and permit valid on the accident date — Answers licence objections.
• Grievance complaint and insurer's reply — Needed for Ombudsman.
• File a written grievance with the insurer and keep the reference — First step before Ombudsman.

What the law says

Saboot will also ask

• What reason did they give?
• Have you complained to the insurer's grievance cell in writing?

Similar 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
• Claim rejected because I told them late
• Insurer says the treatment is not “reasonable and customary”

Sources

• Bima Bharosa — IRDAI complaint portal
• IRDAI — insurance regulator
• Consumer Protection Act, 2019

The full guide: Insurance claim rejected, delayed or underpaid · All situations