Insurance Claim Rejection Complaint
Insurance claim disputes, mis-selling, policy cancellation, and premium refunds
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iGuideline Summary
Insurance companies must acknowledge claims within 15 days and settle or reject within 30 days (health insurance). For life insurance, free-look period is 30 days from receipt of policy document. The Insurance Ombudsman provides free resolution for complaints up to ₹50 lakh, and the office covering your address is listed at cioins.co.in. Bima Bharosa (bimabharosa.irdai.gov.in) is IRDAI’s own grievance portal, which is a different route from the Ombudsman. Either way, a written representation to the insurer comes first. IRDAI Regulations on Protection of Policyholders Interests.
When to File This Complaint
- Insurance claim wrongfully rejected without valid reason
- Settlement amount significantly lower than entitled
- Claim pending beyond stated settlement period
- Policy mis-sold with false promises
- Want to cancel within free-look period but facing resistance
- Premium not refunded after policy cancellation
Documents Required
- Policy document (original or copy)
- Claim rejection letter with reason
- Medical reports, bills, hospital discharge summary (health/life)
- FIR, Panchnama, surveyor report (motor/property)
- Premium payment receipts
- Agent communication records (for mis-selling)
- Death certificate (for life insurance claim)
Common Mistakes to Avoid
- Not exercising free-look period within 30 days
- Missing Ombudsman limitation period (12 months from final rejection)
- Filing Ombudsman without insurer's written rejection first
- Not having written reasons for rejection
- Accepting verbal settlement without written agreement
Frequently Asked Questions
My insurance claim was rejected — what are my options?
First, get the rejection reason in writing. File a formal complaint with the insurer's grievance cell. Once that representation is rejected, or a month has passed with no reply, approach the Insurance Ombudsman — the office covering your address is listed at cioins.co.in.
What is the free-look period for insurance policies?
For life insurance policies, you have 30 days from receiving the policy document to cancel and get a full refund (minus certain charges). For health insurance, free-look period is also 30 days. IRDAI.
How long does Insurance Ombudsman take to resolve complaints?
Insurance Ombudsman typically resolves complaints within 3 months. The Ombudsman offers mediation first, and if that fails, issues an award. The service is free for complainants.
Can I claim if the agent gave wrong information?
Yes, this is considered mis-selling. Keep all agent communications (calls, emails, messages). File complaint with insurer and IRDAI. Include evidence of misrepresentation.
What is the maximum compensation from Insurance Ombudsman?
The Insurance Ombudsman can award up to ₹50 lakh for monetary disputes. Confirm the current ceiling with the Council for Insurance Ombudsmen at cioins.co.in.
Draft Your Complaint
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Escalation Path
- 1Insurance company's grievance cell
- 2Insurance company nodal officer
- 3Insurance Ombudsman (cioins.co.in — the Council for Insurance Ombudsmen lists the office covering your address)
- 4IRDAI consumer affairs (complaints@irdai.gov.in)
- 5Consumer Forum / Civil Court
Important Disclaimer
GetNyay is not a law firm, not an advocate, and is not affiliated with any government body. We do not provide legal representation or guarantee complaint resolution. All information is for educational and self-help purposes only. Users are responsible for verifying final content before submission. Regulator contact details and timelines are informational — always verify at official government portals before relying on them.