If your insurance claim was rejected, delayed, or short-paid in India, there is a defined escalation ladder. Work through it in order — each rung builds the paper trail the next one needs.
Step 1 — Get the rejection in writing
Before anything else, ask the insurer or TPA for the written repudiation (denial) letter that cites the exact policy clause and reason, plus a copy of your policy wording and the claim file. You cannot effectively challenge a rejection you cannot see. This letter is the backbone of every later step.
Step 2 — Insurer's Grievance Redressal Officer (GRO)
Every insurer has a Grievance Redressal Officer. File a dated written grievance (email is fine), attaching the rejection letter and your reasons, and get a complaint reference number. The insurer must acknowledge the grievance immediately and provide a resolution within 14 days of receipt, with reasons referenced to your policy's terms (IRDAI Master Circular on Protection of Policyholders' Interests, 2024). If it is not resolved within 30 days, or the decision is unacceptable, you may approach the Insurance Ombudsman.
Step 3 — IRDAI via the Bima Bharosa portal
If the insurer does not resolve the grievance within 14 days, or the reply is unsatisfactory, escalate to IRDAI through the Bima Bharosa grievance portal (bimabharosa.irdai.gov.in, formerly IGMS). IRDAI takes it up with the insurer and tracks resolution. This is a regulator-backed nudge, not an adjudication, but it often unlocks a stuck claim.
Step 4 — Insurance Ombudsman
You can go to the Insurance Ombudsman once the insurer rejects the grievance, fails to reply within one month, or the reply is unsatisfactory — and you must do so within one year of that. It is free, and the award is binding on the insurer. The Ombudsman can award up to ₹50 lakh (Rule 17(3) proviso (ii)); that cap does not by itself bar a larger claim from being heard — the Kerala High Court (Division Bench, W.A. No. 2121 of 2023, 5 September 2024) and the Madras High Court (W.P. No. 18062 of 2021, 18 April 2024) have held that it limits the award, not which complaints the Ombudsman may entertain. There are 18 Ombudsman offices across India; you file with the one for your jurisdiction, in writing or online at cioins.co.in. Important: come to the Ombudsman BEFORE any consumer forum or court case — under Rule 14(5) of the Insurance Ombudsman Rules, 2017, a complaint is not maintainable if the same subject matter is pending before, or was already decided by, a court, consumer forum, or arbitrator.
Step 5 — Consumer Commission (e-Jagriti) or mediation
Wrongful claim rejection is a "deficiency in service." As an alternative — or where the claim is larger than an Ombudsman award can cover — you can file a consumer complaint online via e-Jagriti (e-jagriti.gov.in) — the National Informatics Centre portal that replaced e-Daakhil on 1 January 2025 — with the District, State, or National Consumer Commission, or resolve the dispute through mediation under the Mediation Act, 2023. Choose based on the amount, urgency, and evidence. Note: filing here permanently closes the Insurance Ombudsman route for the same dispute (Rule 14(5)) — if you want the free, binding Ombudsman award, use it first.
Source: IRDAI Master Circular on Protection of Policyholders' Interests, 2024; Insurance Ombudsman Rules, 2017 (as amended 2021 and 2023); Kerala High Court (Division Bench), W.A. No. 2121 of 2023; Madras High Court, W.P. No. 18062 of 2021. Last reviewed 2026-10-26.