What does my policy's 'conditions' section expect me to do when I make a claim?
Written for policyholders in India · Last reviewed 2026-10-10
The conditions section lists what you must do when something happens: tell the insurer within a set time, send the listed documents, keep records, cooperate with checks and not admit liability on the insurer's behalf. Read it before you need it, because a wording can make following these conditions a precondition of the insurer paying. A late notice or a missing document alone should not end a claim, though — current rules limit how far that can be used against you.
Every general insurance policy must state what you should do when an event likely to lead to a claim happens, and your obligations once it has. A health policy must set out how to submit a claim, the timelines, and what follows if they are not met. These are your side of the contract.[1]
A wording can make these duties a precondition. One insurer's health wording, for example, says the insured person's due observance of the terms and conditions is a condition precedent to any liability to pay a claim.[2]
Duties to look for
| Duty | Example wording | What to do |
|---|---|---|
| Tell the insurer in time | Health: within 24 hours of an emergency admission or before discharge, whichever is earlier; at least 48 hours before a planned admission | Call and also write; note the reference number |
| Send documents within a time limit | Health reimbursement: within thirty days of discharge for the hospitalisation bill | Send what the policy lists; keep copies and proof of sending |
| Keep records and allow inspection | Keep accurate medical records and let the insurer inspect them | Ask the hospital for complete records before you leave |
| Report a theft to the police | Motor theft: report to the police and the insurer immediately and get an FIR or the police's written acknowledgement | Do both the same day if you can |
| Do not admit liability | Motor: no admission, offer or promise to another party without the insurer's written consent | Say you will refer it to your insurer |
| Prevent further damage | Motor: if the car is driven before repair, further damage is at your own risk | Arrange towing rather than driving it |
What a late notice or a missing document does not do
IRDAI's 2024 master circular says no claim shall be rejected or closed for want of documents or for delayed intimation. The insurer must ask for all the documents it needs, as listed in the policy, at one go rather than piece by piece. For health claims, once a claim is intimated, the insurer and its TPA must collect the required documents from the hospital.[1, 5, 6]
For general insurance such as motor, the same circular says an insurer cannot repudiate a claim, in full or in part, for a breached warranty or condition that is not relevant to the nature or circumstances of the loss, or for a delay by the policyholder that did not increase the assessed loss. One insurer's health wording also allows a delay to be condoned where it was beyond your control.[7, 2]
Before you need to claim
Find the claims clause now
The claim documents and procedure must be listed in the policy document and on the insurer's website. Save that list with the policy.[5]
Save the contact routes
Note the claim helpline and email, and the TPA's details if one is named — a health policy must give them.[1]
Tell your family where the policy is
Someone else may have to give notice for you in an emergency.
If you have already missed a deadline
Give notice now, in writing, and explain the delay. Then see a claim refused for late intimation or a late-reported motor claim.
Sources
The official documents this page relies on. Rules change: where it matters to your claim, check the current version at the source.
1. IRDAI (scanned verbatim copy hosted by TaxGuru)
Master Circular on Protection of Policyholders' Interests, 2024, Ref IRDAI/PP&GR/CIR/MISC/117/9/2024 dated 5 September 2024Dated 2024-09-05 · Accessed 2026-10-09 · Cited at: IRDAI Master Circular on Protection of Policyholders' Interests, IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 Sep 2024, Schedule C, para 2.1(xiv); IRDAI Master Circular on Protection of Policyholders' Interests, IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 Sep 2024, Schedule C, para 2.1(xv); IRDAI Master Circular on Protection of Policyholders' Interests, IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 Sep 2024, Schedule C, para 3.1(xx) (p. 97 of the copy read); IRDAI Master Circular on Protection of Policyholders' Interests, IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 Sep 2024, Section 1, Part B, para V.1(ii); Section 2, Chapter V, para 22; IRDAI Master Circular on Protection of Policyholders' Interests, IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 Sep 2024, Schedule C, para 3.1(xxii) (p. 97 of the copy read)
Read from a copy hosted at taxguru.in · Official page
2. The New India Assurance Co. Ltd.
Arogya Sanjeevani Policy - Policy Clauses (UIN NIAHLIP25044V022425)Accessed 2026-10-09 · Cited at: New India Assurance, Arogya Sanjeevani Policy wording (UIN NIAHLIP25044V022425), clause 10.2; New India Assurance, Arogya Sanjeevani Policy wording (UIN NIAHLIP25044V022425), clause 9.3 'Notification of Claim'; New India Assurance, Arogya Sanjeevani Policy wording (UIN NIAHLIP25044V022425), clause 9.2, table row 1 (table cells joined); New India Assurance, Arogya Sanjeevani Policy wording (UIN NIAHLIP25044V022425), clause 10.4; New India Assurance, Arogya Sanjeevani Policy wording (UIN NIAHLIP25044V022425), clause 9.4, Note (c)
3. The New India Assurance Company Limited
Private Car Package Policy – Customer Information Sheet (UIN IRDAN190RP0042V01100001)Accessed 2026-10-09 · Cited at: New India Assurance, Private Car Package Policy Customer Information Sheet, claims obligations item 4 (page 8)
4. The New India Assurance Company Limited
Standard Form for Private Car Package Policy (UIN IRDAN190RP0042V01100001)Accessed 2026-10-09 · Cited at: New India Assurance, Private Car Package Policy wording (UIN IRDAN190RP0042V01100001), Condition 2; New India Assurance, Private Car Package Policy wording (UIN IRDAN190RP0042V01100001), Condition 4
5. Gazette of India (Extraordinary, Part III Sec 4), hosted by Department of Financial Services, Ministry of Finance
IRDAI (Protection of Policyholders' Interests, Operations and Allied Matters of Insurers) Regulations, 2024, F. No. IRDAI/Reg/11/205/2024, Hyderabad, 20 March 2024Accessed 2026-10-09 · Cited at: IRDAI (Protection of Policyholders' Interests, Operations and Allied Matters of Insurers) Regulations, 2024 (Gazette notification F. No. IRDAI/Reg/11/205/2024), regulation 23(4); IRDAI (Protection of Policyholders' Interests, Operations and Allied Matters of Insurers) Regulations, 2024 (Gazette notification F. No. IRDAI/Reg/11/205/2024), regulation 22(1)(a)
6. IRDAI (verbatim copy hosted by the Institute of Actuaries of India)
Master Circular on Health Insurance Business, Ref IRDAI/HLT/CIR/PRO/84/5/2024 dated 29.05.2024 (17 pages, Version 1)Dated 2024-05-29 · Accessed 2026-10-09 · Cited at: IRDAI Master Circular on Health Insurance Business, IRDAI/HLT/CIR/PRO/84/5/2024, 29 May 2024, Chapter I, para 17(c)
Read from a copy hosted at actuariesindia.org · Official page
7. IRDAI (scanned copy of the circular, hosted by caalley.com)
Master Circular on Protection of Policyholders' Interests, 2024 – Ref IRDAI/PP&GR/CIR/MISC/117/9/2024 dated 5 September 2024 (full scanned text with IRDAI letterhead; OCR text layer)Dated 2024-09-05 · Accessed 2026-10-09 · Cited at: IRDAI Master Circular on Protection of Policyholders' Interests, IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 Sep 2024, Section 1, Part C (Retail General), V.4 para 6 (page 46 of the copy read)
Read from a copy hosted at caalley.com · Official page
Free tools
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.
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