How to Appeal a Rejected Insurance Claim in India

A rejected claim is not the final word. IRDAI has created multiple free escalation mechanisms specifically to protect policyholders.

Path 1 — Start Here

Internal Grievance with Your Insurer

Every insurer must have a Grievance Redressal Officer (GRO). File a formal written grievance citing the specific policy clause you believe entitles you to the claim. The insurer must acknowledge within 3 working days and resolve within 14 days.

Success rate: Many rejections at the TPA level are reversed at the insurer's internal grievance stage — particularly where the TPA made a procedural error.

Path 2 — Free and Powerful

Insurance Ombudsman

If your insurer does not resolve within 30 days, approach the Insurance Ombudsman for your region. Completely free, no lawyer needed, and the award is binding on the insurer for claims up to Rs 50 lakh. Find your regional Ombudsman at cioins.co.in.

Timeline: Ombudsman proceedings typically conclude within 3 months. The insurer cannot charge you costs. Awards are enforceable in the vast majority of cases.

Path 3 — IRDAI

IRDAI Bima Bharosa Portal

Register a complaint at bimabharosa.irdai.gov.in. IRDAI uses complaint data to direct insurers to resolve disputes and takes regulatory action against insurers with high complaint rates.

When to use: File with IRDAI simultaneously with the Ombudsman if you believe the insurer has engaged in systematic malpractice.

Path 4 — Last Resort

Consumer Court

For claims above Rs 50 lakh, or if unsatisfied with the Ombudsman award, approach the Consumer Disputes Redressal Commission. Courts frequently award compensation beyond the claim amount including interest and litigation costs.

Note: Never submit originals — always send certified copies and retain originals.

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