My Health Insurance Claim Was Rejected — What Do I Do?

Step 1: Understand why your claim was rejected

The rejection letter must state a reason. Common reasons:

• Non-disclosure of pre-existing disease
• Treatment during waiting period
• Missing documents
• Policy not active / lapsed
• Treatment not covered under policy terms
• Late intimation of hospitalisation

If the reason is documents — simply supply the missing documents and resubmit. If the reason is a policy interpretation dispute — escalate.

Step 2: Escalate within the insurer

Write a formal complaint to the insurer's Grievance Redressal Officer (GRO). Every insurer is required by IRDAI to have one. Send by email (for a paper trail). The insurer must respond within 15 days.

Find the GRO contact on the insurer's website (look for "Grievance" or "Complaints" section).

Step 3: File a complaint on IRDAI's IGMS portal

If the insurer hasn't resolved your issue within 15 days, file on the Integrated Grievance Management System (IGMS):

Step 4: Insurance Ombudsman (free, powerful, effective)

If the insurer rejects your grievance or doesn't respond within 30 days, approach the Insurance Ombudsman. This is completely free. You don't need a lawyer. The ombudsman's decision is binding on the insurer.

Read our full guide: How to use the Insurance Ombudsman →

Step 5: Consumer Forum / Court (last resort)

If all else fails, you can approach the Consumer Disputes Redressal Commission. For claims up to ₹50 lakh, file in the District Commission. This is slower but carries full legal force.

Document everything

At every stage, get written communication. Save all emails, letters, and reference numbers. This paper trail is your most valuable asset in any dispute.