Insurance Claim Rejected

The problem

Your health or life insurance claim was rejected with vague reasons — "non-disclosure," "pre-existing condition," or just a generic denial letter. The insurer won't budge, and you're left paying medical bills out of pocket.

Your legal rights

• IRDAI Regulation 17(6)/(7): Insurers must settle claims within 30 days and provide specific written reasons for any rejection. Vague rejections are regulatory violations.
• Insurance Act §45 (Incontestability): After 2 years from policy start, the insurer cannot repudiate your policy on grounds of non-disclosure or misrepresentation.
• Interest on delayed settlement: IRDAI mandates interest at 2% above bank rate for claims settled after 30 days.
• CPA 2019: Insurance is a "service" — rejection without valid grounds is deficiency in service.

How to escalate

1. Send a legal notice to the insurer citing IRDAI Regulation 17 and demanding settlement + interest.
2. File on IGMS (igms.irda.gov.in) — IRDAI's Integrated Grievance Management System.
3. If unresolved, approach the Insurance Ombudsman (for claims up to ₹50 lakh).
4. File on e-daakhil.nic.in (Consumer Commission) for higher amounts or if Ombudsman order is unsatisfactory.