Insurance Complaint — IRDAI, Bima Bharosa and the Ombudsman
The Insurance Ombudsman is free, binding on the insurer and can award up to ₹50 lakh. The one-year window from the insurer’s rejection is what people miss.
- Who to contact first
- Your insurer’s grievance officer first, then the Insurance Ombudsman for your area — free, and binding on the insurer.
- How to reach them
- Complain to the insurer, then register with IRDAI through Bima Bharosa if needed, and approach the Insurance Ombudsman under the Insurance Ombudsman Rules, 2017.
- How long to wait
- One year from the insurer’s rejection, or one month where the insurer does not reply at all. This is the deadline that ends most insurance complaints before they start.
- If they ignore you
- A consumer commission remains available, and for a life policy section 45 of the Insurance Act is a powerful argument: a policy cannot be called in question on any ground after three years.
Official source · last verified 2 September 2026 — Insurance Ombudsman Rules, 2017 — Council for Insurance Ombudsmen. GetNyay is not affiliated with, endorsed by, or acting for any government department.
Under the Insurance Ombudsman Rules, 2017 you have one year from the insurer’s rejection to approach the Ombudsman — or one month where the insurer simply does not reply. Months of back-and-forth correspondence after a rejection do not extend it. This is why a verbal refusal is worth nothing to you: insist on the rejection in writing, diarise the date, and treat everything after it as running against a clock.
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All contact channels
Every channel below was read on an official page. Contact details change — the source for each is linked in the verification footer at the end of this page.
The escalation ladder, level by level
Work through these in order. Every forum above asks what you did below, and skipping a rung is the commonest reason a complaint is sent back.
- 1Insurer grievance officerWait One month before the Ombudsman route opens on non-reply
The insurer’s grievance redressal officer.
The policy number, the claim number, the date of rejection and the ground given. Insist on the rejection in writing — a verbal refusal starts no clock.
- 2IRDAI grievance registrationWait Not a substitute for the Ombudsman
IRDAI, through Bima Bharosa.
bimabharosa.irdai.gov.in
The policy and claim numbers and the insurer’s reference. Registering here does not stop the Ombudsman clock, so do both.
- 3Insurance OmbudsmanWait One year from rejection; one month where the insurer does not reply
The Insurance Ombudsman for your area.
cioins.co.in
The written rejection, the policy, the claim papers and the medical records where relevant. Free, and no lawyer required.
- 4Consumer Commission — e-JagritiWait Two years from the cause of action
The consumer commission, where the Ombudsman route is closed or unsuitable.
e-jagriti.gov.in
The policy, the rejection and proof of premium paid.
How the process runs
- 1Get the rejection in writing
A verbal refusal starts no clock and proves nothing. Ask for the ground of rejection in writing and note the date.
then: one year runs from here - 2Complain to the insurer’s grievance officer
Named in your policy document. Take the reference. Where the insurer does not reply at all, the Ombudsman route opens after a month.
then: if unresolved - 3Register with IRDAI on Bima Bharosa
Do this as well as, not instead of, the Ombudsman — it does not pause the one-year window.
then: and in parallel - 4Approach the Insurance Ombudsman
Free, no lawyer, binding on the insurer, up to ₹50 lakh. Find the Ombudsman with jurisdiction over your area.
then: if that route is closed - 5Consumer commission
Two years from the cause of action. Useful where the one-year Ombudsman window has already passed.
What this system will not take up
Filing one of these wastes the whole period — it is closed on that ground alone.
- Anything pending before a court.
- A dispute above the Ombudsman’s ₹50 lakh ceiling, which goes to a commission or court.
- A complaint brought more than one year after the insurer’s rejection.
- Commercial underwriting judgment — an insurer’s decision on what premium to quote.
What to have ready before you complain
Assemble these first. A complaint that opens with the identifying numbers gets routed; one that opens with how long this has been going on gets a template reply.
- The policy document, and the schedule showing sum insured and conditions.
- The claim number and every claim form submitted.
- The insurer’s written rejection, with its date — the Ombudsman clock runs from this.
- Medical records, discharge summary and bills for a health claim.
- Premium payment proof, showing the policy was in force.
- For a cashless denial, the timestamp of the request and the denial.
Timelines at a glance
How long to wait at each stage, and where that period comes from.
| Stage | Window | Where it comes from |
|---|---|---|
| Ombudsman filing window | One year from the insurer’s rejection; one month where the insurer does not reply | Insurance Ombudsman Rules, 2017 (as amended to 2021) |
| Ombudsman award ceiling | ₹50 lakh | Insurance Ombudsman Rules, 2017 |
| Cashless authorisation (health) | Within one hour; final authorisation within three hours | IRDAI Master Circular on Health Insurance Business (2024) |
| Health claim decision | Within 30 days, with interest at bank rate plus 2% on delay | IRDAI Master Circular on Health Insurance Business (2024) |
| Life policy — no repudiation after | Three years | Insurance Act, 1938 — Section 45 |
Common complaints handled here
Who runs this, and who is above it
Insurance Regulatory and Development Authority of India
IRDAI regulates insurers and takes grievances through Bima Bharosa, but the body that decides your claim dispute and makes a binding award is the Insurance Ombudsman, under the Insurance Ombudsman Rules, 2017. It is free, needs no lawyer, and awards up to ₹50 lakh — which makes the one-year window from rejection the single most valuable date in an insurance dispute.
https://irdai.gov.in/ →If they ignore you — where to go next
What each forum costs and what it needs before it will take your case.
The written rejection, within one year. Awards up to ₹50 lakh and binds the insurer.
Two years from the cause of action. Useful where the Ombudsman window has closed.
Frequently asked questions
How long do I have to go to the Insurance Ombudsman?
One year from the insurer’s rejection of your claim, under the Insurance Ombudsman Rules, 2017. Where the insurer does not reply at all, the route opens after one month. Continued correspondence after a rejection does not extend the year, which is why the date on the written rejection matters more than anything else in the file.
How much can the Insurance Ombudsman award?
Up to ₹50 lakh under the Insurance Ombudsman Rules, 2017. The process is free, requires no lawyer, and the award binds the insurer. For most individual health, life and motor claims that ceiling is well above the amount in dispute, which makes it a far better first route than a court.
My cashless request was denied at the hospital. What are the timelines?
The IRDAI Master Circular on Health Insurance Business (2024) requires cashless authorisation within one hour of the request and final authorisation within three hours. A claim decision is required within 30 days, with interest at bank rate plus 2% where settlement is delayed. Note the timestamps of your request and the denial — those are the facts the complaint turns on.
My life insurance claim was repudiated for non-disclosure. Is that final?
Not necessarily, and section 45 of the Insurance Act, 1938 is the provision to know: a life policy cannot be called in question on any ground after three years from the relevant date. If the policy had run beyond three years, a repudiation on non-disclosure faces a serious statutory obstacle — say so explicitly in your complaint, citing the section and the policy commencement date.
Should I go to IRDAI or the Ombudsman?
Both, but understand what each does. Registering on Bima Bharosa puts the grievance in front of the regulator and can prompt the insurer. Only the Ombudsman decides your dispute and makes a binding award. Crucially, registering with IRDAI does not pause the one-year Ombudsman window — so do not let a Bima Bharosa complaint run that clock down.
Is the Insurance Ombudsman free?
Yes, and no lawyer is needed. That combination — free, no representation, binding on the insurer, up to ₹50 lakh — is why it is almost always the right first destination for a rejected claim, ahead of a consumer commission. Anyone charging a fee to file an Ombudsman complaint for you is selling something you can do yourself.
Letter and notice formats
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Related escalation guides
Every contact detail on this page was read on an official page — primarily Insurance Ombudsman Rules, 2017 — Council for Insurance Ombudsmen. Government contact details change without notice. If something here is out of date, tell us and we will check it.
What we deliberately left blank (2)
- — Ombudsman office addresses by jurisdiction — find the one covering your area on cioins.co.in.
- — Bima Bharosa was not opened directly when this page was built; the portal address is corroborated from IRDAI-attributed material.