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 grounds insurers cite — 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. Demand the clause.

Next, marshal your evidence. For pre-existing disease rejections, your old medical records can show whether the disease existed before the policy. For non-disclosure, showing the condition was unrelated is an argument, not a guarantee: the Supreme Court has upheld repudiation of a mediclaim policy where a known material condition was answered inaccurately on the proposal form (Civil Appeal No. 2776 of 2002, decided 10 July 2009). For medical necessity, ask the treating doctor for a letter explaining why the admission was needed.

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, take it to the Insurance Ombudsman (free, binding on the insurer) within one year of the rejection or final reply; a complaint to IRDAI on Bima Bharosa is optional, not a precondition. 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 Strategy Note (₹999) gives you a written, specialist-approved assessment of whether the rejection holds up. If it does not, the Note sets out your next steps, and BimaHaq can prepare a Bima Bharosa complaint or a custom Ombudsman package with supporting case laws and your policy's terms.