Your Genuine Insurance Claim Was Rejected? Here’s What You Can Do Next

💡 A Valid Claim Rejected? Don’t Lose Hope

One of the most common — and frustrating — experiences faced by policyholders is when their genuine insurance claim gets repudiated. You’ve paid your premiums diligently, filed your claim honestly, and still receive a denial letter citing technical grounds or vague policy terms.

But the story doesn’t end there.

The Insurance Regulatory and Development Authority of India (IRDAI) has mandated structured grievance redressal mechanisms to ensure policyholders have proper avenues to raise their concerns and fight back against unjust rejections.

In this article, we’ll walk you through what steps you can take if your insurance claim is wrongly denied, and how to escalate the matter — with or without a lawyer.

📍 Step 1: File a Complaint with the Grievance Redressal Officer (GRO) of the Insurance Company

As per IRDAI regulations, every insurance company is required to appoint a Grievance Redressal Officer (GRO) to handle insurance related grievances.

If you believe your claim has been wrongfully repudiated, your first official step is to submit a written representation or complaint to the insurer’s Grievance Redressal Officer (GRO)

✅ How to Contact the GRO:

Visit the insurer’s website → Locate the “Grievance Redressal” section
Send a written complaint via email or physical letter
Mention your policy number, claim details, and grounds for objection
Attach relevant documents (rejection letter, correspondence, medical records, bills, etc.)

Insurance companies are required to respond to complaints within 15 days from the date of filing.

💡 Pro Tip: Keep a copy of all correspondence for future use. If the insurer doesn’t respond or gives an unsatisfactory reply, move to the next level.

📍 Step 2: Escalate the Issue to the Insurance Ombudsman (Retail & MSME Customers Only)

If the GRO’s reply is unsatisfactory or there is no response within 30 days, retail policyholders and small businesses (MSMEs) can approach the Insurance Ombudsman.

🧑‍⚖️ Who Can File a Complaint with the Insurance Ombudsman?

Individual policyholders (life, health, motor, etc.)
Micro and Small Enterprises (MSMEs)
Claim amount under ₹30 lakhs
Complaint must relate to personal insurance policies only, not corporate/group policies

🚪 What Kind of Cases Can the Ombudsman Hear?

Rejection of claims without proper justification
Delays in claim settlement
Disputes over policy terms
Issues related to premium payments or policy servicing

📍 How to File the Complaint:

File the complaint online at https://www.cioins.co.in
Submit a written complaint to the Ombudsman’s office in your region
Include copies of your GRO complaint and insurer’s response (if any)

⏳ Timeline:

The Ombudsman usually resolves complaints within 90 days
If the award is in your favor, the insurance company must comply within 30 days

❗ Remember: The decision of the Insurance Ombudsman is binding on the insurer, but not on you. If you are dissatisfied with the outcome, you still have legal recourse.

📍 Step 3: File a Case in Consumer Court (If Needed)

Whether or not you approached the Insurance Ombudsman, you still have the right to take your grievance to the Consumer Court — especially when:

You are not eligible to approach the Ombudsman (e.g., corporate clients, group policies)
You are dissatisfied with the Ombudsman’s award
There has been a gross violation of service or contract

You can file the complaint yourself, but it is advisable to consult a legal professional with experience in insurance claim disputes, for which we at iClaimSupport can assist and take up the matter for you.

🧭 Which Redressal Path Should You Take?

Each grievance redressal mechanism is designed for a different stage of dispute resolution. Depending on your case, you may need to escalate step by step.

Start with the Grievance Redressal Officer (GRO) of the insurance company for an internal resolution.
If you’re a retail policyholder or MSME and the issue remains unresolved or the response of the GRO is unsatisfactory, escalate to the Insurance Ombudsman.
If you are dissatisfied with the decision of the Insurance Ombudsman, or the GRO, or are not eligible to file under the Ombudsman mechanism, you can take your case directly to the Consumer Court for legal remedy.

Choosing the right course of action is key. At iClaimSupport, we assist you through the entire process — from drafting effective complaints to preparing a strong claim case.

🆘 Need Help with Your Denied Insurance Claim?

Don’t let an unfair rejection go unchallenged. Your policy is a legal contract, and if your claim is genuine, you have every right to be paid.

📞 Call us: +91-9871820066
📧 Email: contact@iclaimsupport.in
🌐 Visit: www.iclaimsupport.in

We’re here to ensure your voice is heard — and your rightful claim is settled.

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