How to read a claim rejection letter

Written for policyholders in India · Last reviewed 2026-10-10

A rejection letter is a short argument wrapped in a long form. Four things in it decide what you do next; the rest is administration.

1. The claim and policy references

The claim number and policy number appear near the top. Every later letter you write should quote both, and any mismatch between the letter and your policy document is itself worth asking about.

2. The decision

Find the sentence that states the outcome: repudiated, rejected, closed, settled in part. The word matters — a partial settlement and a repudiation start different conversations.

3. The reason, and the clause behind it

This is the sentence your grievance answers. Write it down exactly, including any clause number it gives, and then read that clause in full in your own policy wording.

If the letter gives a reason but no clause, ask for it. For health claims, the insurer must give full details with reference to the specific terms of the policy; for any claim, its reply to your complaint should give reasons that refer to the policy terms. For a life policy, no claim may be repudiated without legally tenable evidence.

4. What they relied on

A letter may list the documents considered — a discharge summary, a proposal form, an investigator's report. Where it does, that list tells you which facts are in play, and which of your documents may contradict them.

Then check the dates

Note the date of the letter and the date you received it. The Insurance Ombudsman must be approached within one year of receiving the insurer's rejection of, or unsatisfactory reply to, your written complaint — or, if it never replies, within one year of the end of one month after you sent the complaint — so those dates are part of your case.