How to ask for the documents the insurer relied on — investigation reports, and where RTI fits

Write to the insurer and ask for a copy of every document named or relied on in its decision — an investigator's report, statements, hospital records it obtained, the proposal form — and for the policy clause applied to each ground. For life claims, IRDAI's master circular says no claim may be repudiated without legally tenable evidence, so asking to see that evidence is reasonable. Where the insurer is a 'public authority' under the Right to Information Act, 2005 — LIC, for example, has an RTI page with an online application link — an RTI request is a parallel route, but it does not pause your complaint deadlines.

Several rules point the same way. For health claims, a rejection or partial disallowance must come with "full details giving reference to the specific terms and conditions of the policy document". The 2024 regulations ask insurers to "Provide information at various stages of claim settlement".^{[1, 2]}

For life policies, IRDAI's master circular says: "No claim shall be repudiated by the insurer without obtaining legally tenable evidence to substantiate such repudiation." Asking to see that evidence is a fair request.^[3]

What to ask for

• The investigator's report: And any statements recorded from you, the hospital or others during the investigation.
• Records the insurer obtained: Hospital papers, earlier claim records or test reports it collected itself.
• The proposal form and pre-policy reports: Where non-disclosure is alleged. See getting the proposal form.
• The clause for each ground: The exact policy terms applied, if the letter does not name them.
• Confirmation of the committee's approval: For health claims, the circular says no claim shall be repudiated without the approval of the Product Management Committee or its Claims Review Committee. It does not say you can see the committee's papers, but asking whether that approval was given is reasonable.^[1]

A request paragraph you can adapt

Put the request in the same letter as your grievance, or send it first and refer to it in the grievance. Either way, its date goes into your claim timeline.

Right to Information, where the insurer is a public authority

The Right to Information Act, 2005 gives citizens a right to information held by a 'public authority'. The Act's definition of that term includes a body set up by a law made by Parliament, and any body owned, controlled or substantially financed, directly or indirectly, by funds the government provides. It does not name insurers, and this page does not decide whether yours is covered.^[4]

So start with the insurer's own RTI page. LIC, for example, has an RTI Center page carrying its "DISCLOSURES ( under Section 4 (1) (b) )" and a link for an "Online RTI Application/Appeal". Check your insurer's website for such a page and its Public Information Officer before you apply.^[5]

Do not wait for an RTI reply before complaining. The one-year limit for going to the Insurance Ombudsman runs from the insurer's rejection or its unsatisfactory reply to your complaint or, if it never replies, from the end of one month after you sent the complaint; the Rules do not tie it to any information request.^[6]

If the insurer will not share

Record the refusal and its date, and say in your complaint that you asked. If the matter reaches the Insurance Ombudsman, the Rules give the Ombudsman power to ask either side for additional documents and to "collect factual information relating to the dispute available with the insurer".^[6]

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.

More on claim documents and evidence