Your insurance claim was rejected. Here's what to do next.

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

A rejection is not the end of a claim. It is the insurer's position, written down — and a position can be answered, provided you answer the reason they actually gave rather than the one you think they gave.

This page explains how to read the decision, what to check in your policy, which evidence matters, and the routes available to you if you disagree.

Start with the exact reason, in their words

For a health claim, IRDAI requires the rejection to give full details with reference to the specific terms and conditions of your policy, so the letter should name the clause it relies on. Everything you do next hangs on which ground it is. "Pre-existing disease" is a different argument from "policy lapsed", which is different again from "treatment not medically necessary".

Find the sentence that states the reason, and the clause number beside it. That sentence is what your response has to answer.

Grounds a rejection may rest on

Grounds you may see in health and motor rejections include the following. Each one is answerable in a different way — and some rest on facts you may be able to disprove with documents you already have.

Pre-existing disease: The insurer says the condition existed before the policy began and is still inside the waiting period. The argument turns on dates — when the condition was first diagnosed, and when advice or treatment for it was first recommended or received — and those dates sit in your medical records.
Non-disclosure: Something in the proposal form is said to be wrong or missing. Check what was actually asked, and what was actually answered; the two are sometimes not the same question.
Waiting period not served: The policy excludes the treatment for a set period from inception. Whether it applies depends on the policy's own dates and on continuous renewals from an earlier policy.
Exclusion in the policy: The treatment is listed as not covered. Read the exact words and any exceptions attached to them. An insurer may rely only on exclusions written into your policy document.
Not medically necessary: The insurer disputes that the admission or procedure was required. The treating doctor's notes and the discharge summary carry the weight here.
Late intimation or missing documents: Procedural grounds. IRDAI's 2024 master circular says a claim cannot be rejected or closed only for missing documents or late intimation, so reply with the dates, supply anything genuinely missing, and ask for a decision on the merits.

Check the reason against your own policy

The first thing to do is put the rejection letter and the policy wording side by side, and read the clause the insurer cited — the whole clause, including its exceptions.

A clause can be narrower than the letter's summary of it. A waiting period may not apply to an accident; an exclusion may carve out the exact situation you are in; a definition elsewhere in the policy may decide what a word in the clause means.

Gather the evidence that answers that reason

Evidence is anything that proves a fact the insurer's reason depends on. Which documents matter follows directly from the ground they used.

The policy wording and schedule: The contract itself, and the dates and sums that apply to you.
The rejection letter: The reason and the clauses relied on.
Discharge summary and case notes: What the treating doctor recorded, including when a condition was first known.
Bills and payment receipts: What was spent, and on what.
Earlier policies: Continuous cover from an earlier year can change which waiting periods apply.
Correspondence: Every message to and from the insurer, with dates.

The routes open to you in India

Complain to the insurer in writing first. You can also register the complaint on Bima Bharosa, but the Insurance Ombudsman needs only your prior written complaint to the insurer, not a Bima Bharosa complaint.

The insurer's grievance officer: Every insurer has one. This is where a written complaint goes first, quoting the claim number and answering the stated reason.
The regulator's grievance portal (Bima Bharosa): If the insurer's answer does not resolve it, you can register the complaint on IRDAI's portal. It is an option alongside the Ombudsman, not a step you must take before it. Check the current process on the official site.
The Insurance Ombudsman: A free forum for policyholders. You can approach it once the insurer has rejected your written complaint, replied unsatisfactorily, or not replied within one month. Its conditions also cover time limits, claim value and whether the matter is already before a court; check the conditions in force before relying on them.

What to avoid

Do not send an angry letter that argues with the tone of the decision rather than its substance. Do not guess at figures or dates: an error in your complaint becomes the insurer's reply.

And do not let the calendar run. The Insurance Ombudsman must be approached within one year of receiving the insurer's rejection or unsatisfactory reply or, if the insurer does not reply at all, within one year of the end of one month after you sent your written complaint. The Ombudsman can condone a delay in some cases, but do not rely on it.