Your Health Claim Was Rejected. It Is Not Over.

A rejection letter feels final. It is not — it is the insurer's position, and you are entitled to contest it. The most common grounds — pre-existing disease, non-disclosure, medical necessity, waiting period, and documentation — each have established regulatory rules and case law that a policyholder can rely on. Whether they help in your case depends on your facts, which is exactly what a review establishes.

The first step is to get the rejection in writing. By IRDAI rules, the insurer must give you the specific clause it is invoking. A vague rejection letter is not a valid rejection. Demand the clause. If the clause is unclear, that itself is grounds for reversal.

Next, marshal your evidence. For pre-existing disease rejections, your old medical records often show the disease did not exist before the policy. For non-disclosure, the alleged condition must be material to the claim — unrelated non-disclosure is not grounds. For medical necessity, the treating doctor's letter outweighs the insurer's reviewer.

Then escalate. Write to the insurer's Grievance Redressal Officer — they must acknowledge immediately and resolve within 14 days. If that lapses or the reply is unsatisfactory, escalate to IRDAI on Bima Bharosa, and to the Insurance Ombudsman (free, binding on the insurer) within one year of the rejection or final reply. Go to the Ombudsman BEFORE any consumer forum: under Rule 14(5) it cannot take up a matter already pending or decided elsewhere.

Our Claim Rejection Review (₹4,999) gives you a written legal opinion on whether the rejection holds up. If it does not, we draft your grievance and pursue the case until the money is paid.