Claim scenarios
Each page walks one invented situation from start to finish: what the insurer's letter says, what to check against the policy, which documents answer the reason, and where a complaint goes next. The rules each walkthrough relies on are cited on that page, and its related pages explain them further.
Use them to see the method, then apply it to your own documents.
Start here
- Scenario: no reply from the insurer — using Bima Bharosa while preparing for the OmbudsmanAn illustrative walkthrough of an unanswered insurance complaint, with Bima Bharosa and the Insurance Ombudsman used in parallel and each clock side by side.
- Scenario: a PED rejection where the diagnosis came after the policy startedAn illustrative walkthrough of a health claim rejected as pre-existing disease where the diagnosis came after the policy began: the dates, documents and letter.
- Scenario: cashless denied at admission — what to do at the desk and afterwardsAn illustrative walkthrough of a cashless request refused at a network hospital: what to ask at the desk, the one-hour rule, and claiming reimbursement after.
Worked scenarios
- Scenario: a partial settlement with room-rent, consumables and 'reasonable charges' deductionsAn illustrative walkthrough of a health claim paid in part, with room-rent, consumables and reasonable-charges deductions traced to the clauses behind them.
- Scenario: a car repair claim with depreciation and a disputed surveyor estimateAn illustrative walkthrough of a car repair claim where the surveyor's figure falls short of the garage estimate: survey rules, depreciation and what to ask.
- Scenario: a parent's death claim rejected for non-disclosure within three yearsAn illustrative walkthrough of a life insurance death claim rejected for non-disclosure within three years: what Section 45 requires and what to check.
- Scenario: a stolen vehicle, a pending police final report, and a long theft claimAn illustrative walkthrough of a car theft claim waiting months for the police's untraced report: the documents asked for and how to keep it moving.
- Scenario: preparing an Ombudsman complaint close to the one-year limitAn illustrative walkthrough of an Insurance Ombudsman complaint prepared close to the one-year limit: fixing the start date, the minimum documents, late filing.
- Scenario: an admission called 'not medically necessary' — building the clinical evidenceAn illustrative walkthrough of a short hospital stay rejected as not medically necessary: the policy definition, the records that answer it, a doctor's note.
Free tools
Claim Rejection Reason ExplainerFind the ground your insurer used — pre-existing disease, non-disclosure, a waiting period, an exclusion — and see what it rests on, what to check in your policy, and what answers it.Insurance Claim Document ChecklistA checklist for a rejected, delayed, short-paid or cashless-refused claim in India: what to gather, why each document matters, and what it proves.
ClaimAssure is an independent private platform. It is not an insurer, IRDAI, Bima Bharosa or the Insurance Ombudsman, it never files anything on your behalf, and it cannot promise any outcome. What it does is read your documents and show you what they say.