A rejection is the start of a process, not the end of it. Indian insurance law and the IRDAI rules give a policyholder several standing protections that apply across almost every kind of dispute. None of this is legal advice; these are general principles to check your own rejection against.
The insurer carries the burden, not you
When an insurer repudiates a claim, it is the insurer that must prove the ground it relies on — that a fact was material and knowingly withheld, that an exclusion clearly applies, that a breach actually occurred. A bare assertion is not proof. You are not required to disprove a reason the insurer has not first established.
Every rejection must be reasoned and in writing
A repudiation has to state the specific ground and reference the exact policy clause and the material relied on. A letter that just says "non-disclosure" or "claim not payable" without identifying the clause and the record behind it is procedurally deficient — you are entitled to ask for the clause and the material, and the absence of a reasoned, written rejection is itself a point in your favour.
Ambiguity is read against the insurer (contra proferentem)
The insurer drafts the policy, so where a clause is genuinely ambiguous it is construed against the insurer and in favour of cover. An exclusion cannot be stretched beyond its defined words, applied more broadly than written, or relied on if it was never clearly disclosed to you at the time of sale.
Non-disclosure has to be material — and there are hard limits on it
To defeat a claim for non-disclosure the insurer generally has to show you suppressed a fact material to the risk. Two strong limits work in your favour. First, once a health policy has run continuously for the IRDAI moratorium period (five years), it cannot be questioned for non-disclosure or misrepresentation at all, except for proven fraud. Second, where the insurer's own agent filled in the proposal or you signed a blank form, the plea is often treated as weakened. One honest caution: Indian courts are divided on whether the undisclosed fact must be connected to what you actually claimed for — the Supreme Court has upheld repudiation for a material non-disclosure even where it had no link to the cause of the claim — so an unrelated omission is not automatically safe. Treat the lack-of-nexus point as an argument to press on your facts, not a guarantee.
Life policies become incontestable after three years
Under Section 45 of the Insurance Act 1938, once a life policy has run for three years — counted from the latest of its issuance, commencement of risk, revival, or a rider — it cannot be called in question on any ground whatsoever, including fraud. Within those three years the insurer may repudiate, but it carries the burden and must put its grounds and material to you in writing. Note that a revival restarts a fresh three-year clock, which is the insurer's usual counter.
Documents and a late intimation are not free passes to reject
Under the 2024 IRDAI rules an insurer cannot reject a claim for documents it could obtain itself, nor keep raising piecemeal document demands, and it must give you a reasonable opportunity to supply a genuinely required document before closing the claim. Likewise, a delay in informing the insurer does not defeat a genuine claim unless the insurer can show the delay actually prejudiced its ability to investigate.
A "full and final" voucher signed under pressure is not a bar
If you signed a discharge voucher or consent letter accepting a lower amount as "full and final", that does not automatically end the matter. A voucher signed under protest, under financial duress, or without free consent — the common situation where a claimant needs the money and signs whatever is put in front of them — does not bar you from pursuing the balance. Consent obtained by undue influence does not bind.
The insurer is held to the grounds it first stated
An insurer is generally confined to the reason it gave in its repudiation letter. It cannot keep changing or adding fresh grounds later to justify the same rejection when the first reason does not hold up — a shift in the stated ground is itself a weakness in the insurer's case.
A surveyor's report is evidence, not the last word
In motor and property claims the surveyor's report matters, but it is not conclusive or binding. It can be challenged with contrary material, and the insurer must apply its own mind to the claim rather than mechanically adopt a low or wrong assessment.
Delay is a wrong in itself — and it earns you interest
Every stage of a claim runs against a regulated clock. Miss the IRDAI timeline and the insurer must pay you interest at the bank rate plus 2%, from the date it received intimation until it pays — automatically, without you having to ask. Delay in settlement is also a stand-alone ground of complaint to the Insurance Ombudsman under Rule 13(1)(a) of the Insurance Ombudsman Rules 2017, separate from any dispute over the merits.
A part-paid claim is a dispute you can pursue
A claim that is only partly paid is a grievance in its own right. The Insurance Ombudsman expressly hears partial repudiations, not only outright rejections, and when a claim is disallowed in part the insurer must give clause-wise reasons tied to your policy.
What you can ask for
A grievance is not limited to the claim amount. Depending on the facts you can seek the sum wrongly withheld, interest on it for the period of delay, and — before a Consumer Commission — compensation for the harassment and mental agony caused and the costs of pursuing the claim.
The path
Get the written repudiation with its exact clause and material; gather the documents that answer that specific reason; raise a written grievance with the insurer's Grievance Redressal Officer; and if it is not resolved, escalate the ladder — IRDAI Bima Bharosa, then the Insurance Ombudsman (free, binding on the insurer within 30 days), and the Consumer Commissions where appropriate.
Source: Insurance Act 1938 (incl. s.45); IRDAI (Protection of Policyholders' Interests / health) regulations and 2024 Master Circulars; Insurance Ombudsman Rules 2017; established principles of insurance-contract interpretation. Last reviewed 2026-07-25.