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What to do if the insurance company rejects your claim  

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What to do if the insurance company rejects your claim?

 

Ask a common man what they feel about insurance and they will say it’s not worth it. There is a general perception that insurers do not settle claims. They find ways to reject it in some of the other ways. However, one should not give up. If you feel your claim is genuine, you should fight for it or seek help. We shall tell you how. 

One of the major reasons why insurers get their way is because the legal language and the paperwork that they do gets too complex for the policyholder. A common man may not be able to respond to the insurer in the similar legal language that they use. Here comes the role of Insurance Samadhan. 

“You can’t get emotional with them. You don’t have to plead. We at Insurance Samadhan help you in communicating with them in their language. We help the dejected policyholders present their case before insurers logically,” says Shailesh Kumar, Head of Insurance & Co-founder at Insurance Samadhan.

You may contact them at 844844626.

If you feel you want to fight the case yourself, you may directly reach out to the concerned insurance company. You may escalate the matter with the insurance regulator, Insurance Regulatory and Development Authority of India (IRDAI), too. 

Approach the insurer

All insurers will have a grievance redressal cell. Write to them challenging the reason for the rejection of the claim. It should be concise and clear supported by all relevant documents. 

It is mandatory for the insurers to respond to your grievance within 15 days. 

Also Read:  Why Accidental Insurance is Important?

Approach IRDAI

If you are dissatisfied with their response, approach the Grievance Redressal Cell in the Consumer Affairs Department of the IRDAI. There are different ways to reach out to it: 

i) Submit complete details as required in the complaint registration form put on the IRDAI website – policyholder.gov.in. 

  iii) Visit the Integrated Grievance Management System (IGMS) –  IRDAI Portal at  – to register and monitor the complaint. 

iii) send the complaint through Email

iv)       Call Toll-Free No. 155255 or 1800 4254 732.

v) You may also send the complaint in the physical form on the following address:

General Manager

Insurance Regulatory and Development Authority of India(IRDAI)

Consumer Affairs Department – Grievance Redressal Cell.

Sy.No.115/1, Financial District, Nanakramguda, 

Gachibowli, Hyderabad – 500 032

Reach out to the Ombudsman 

Policyholders can approach the Ombudsman with complaints if:

They have first approached the insurance company with the complaint and

• they have rejected it

• not resolved it to their satisfaction or not responded to it at all for 30 days

• complaint pertains to any policy they have taken in their capacity as an individual and

• the value of the claim including expenses claimed is not above Rs 20 lakhs.

The processes are aplenty. What matters is framing your case logically and being thorough with it. Insurance Samadhan can help you with it in a timely manner.

Aprajita Sharma

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