Appealing a rejected claim, step by step

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

There is no single "appeal button" in Indian insurance. What exists is a set of routes: ask the insurer to reconsider first; after that you can ask IRDAI to look at it through Bima Bharosa, or go to the Insurance Ombudsman, which expects you to have complained to the insurer in writing first.

Reconsideration by the insurer

A reconsideration request is a letter to the grievance officer that answers the stated reason with facts and clause wording. New evidence — a medical record showing a diagnosis date, an earlier policy showing continuous cover — is what can move it.

What makes an appeal persuasive

Specificity. Quote their reason, name the clause, show the document that contradicts it, and state clearly what you want. Anything you cannot prove weakens what you can.

Keep the record as you go

Every letter, reference number and date becomes part of the case if it escalates. Escalation forums look at the sequence as much as the substance.

Keep your own copy of everything you send, and note how you sent it. A complaint that can show what was sent and when is in a different position from one that remembers it.

Facts that can answer the stated reason

A reconsideration is argued on facts, not on tone. These are the kinds of facts that bear directly on the insurer's stated ground.

A date that contradicts the stated reason: Where a claim is refused as pre-existing, a medical record showing first diagnosis after the policy began is strong evidence against that ground — but the definition also covers medical advice or treatment within 36 months before the policy began, so check the earlier records too.
Proof of continuous cover: Earlier policies, renewed without a break, can move the start of a waiting period years earlier than the current policy's date, depending on your policy wording and whether the earlier cover was with the same insurer or ported.
The full clause: Exclusions can carry exceptions. A clause quoted in part in the letter may, read whole, not cover your situation at all.
What the treating doctor actually wrote: Where necessity is disputed, the clinical notes are the evidence — not the insurer's reading of a summary line.
The question as it was really asked: Where non-disclosure is alleged, compare the proposal form's wording to the answer given. The two are sometimes about different things.

How long it takes, and what to do meanwhile

IRDAI's 2024 master circular says insurers should resolve a complaint within 14 days and give reasons that refer to the policy terms. Rules change, so check the current circular.

While you wait, keep collecting: anything that proves a fact the insurer's reason depends on is worth having before the next stage, not after it.