What should I ask for in my insurance grievance?

Ask for something definite that your documents support: that the insurer reconsider and pay the claim or the amount it deducted or, at the least, give a reasoned decision that cites the policy terms it relies on. If a claim was paid late, ask whether the interest that IRDAI's rules provide for delay has been paid. Leave out amounts and demands you cannot support; no wording can force a particular outcome.

The last paragraph of a grievance is the one people rush, and it decides what the reply has to answer. A clear request also carries forward: a complaint to the Insurance Ombudsman must state the relief sought, so it helps if the insurer was asked for the same thing first.^[1]

Requests that are specific and supportable

• Reconsider and pay: Ask the insurer to reconsider the decision and settle the claim, or the part it deducted, naming the amount from your claim form or settlement sheet. If only some items are in dispute, list them.
• Reasons that cite the policy: If the insurer does not accept your complaint, its resolution should give reasons with specific reference to the policy terms. For health claims, a rejection or a partial disallowance must also be explained with reference to the specific terms relied on. It is a fair thing to ask for.^{[2, 3]}
• Interest for delay: IRDAI's master circular entitles a claimant to interest at the bank rate plus 2 percent when a claim is not settled within the specified timelines, from receipt of intimation to payment, and says insurers must pay it on their own. 'Bank rate' means the RBI rate on the first day of the financial year in which the claim fell due.^{[4, 5, 6]}
• The documents relied on: Ask for copies of the reports the decision relied on, such as an investigation report. See asking for the documents the insurer relied on.
• A correction: If the dispute comes from wrong details in the policy, ask for the correction in writing.

How to word it

One short paragraph is enough. For example: 'I request that you reconsider your decision dated [date] and settle the claim of [amount claimed], with interest for delay as provided in IRDAI's master circular. If you maintain the decision, please give your reasons with reference to the specific policy terms relied on.'^{[4, 2]}

Then stop. A request buried in the middle of a long letter is easy to miss; a request that stands alone at the end is hard to ignore. The complaint email outline shows where it sits.

What not to ask for

• Amounts with no basis: Compensation for distress, or 'goodwill' sums with no basis in the policy. Even the Insurance Ombudsman cannot award ex-gratia payments, and its award cannot exceed the loss you directly suffered or ₹50 lakh.^{[7, 1]}
• Interest you have calculated yourself: Ask for interest as the rules provide rather than a figure of your own: the rate depends on the bank rate for the relevant year, and at least one policy wording starts the interest from a different date: receipt of the last necessary document.^{[6, 8]}
• An order from the regulator: IRDAI reviews complaints for possible violation of its regulations; its pages do not describe it ordering payment of a particular claim. See what the regulator can and cannot do.^[9]
• Threats: Threats, or deadlines you will not act on, give the reader something to answer other than your point.

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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