Question 1

What can I do if my insurance claim is rejected in India?

Accepted Answer

You have a statutory right to appeal. Step 1: File a written grievance with the insurer's Grievance Redressal Officer (GRO) — they must respond within 15 days under IRDAI regulations. Step 2: If unresolved, escalate to the Insurance Ombudsman in your region. Step 3: File in Consumer Court. ClaimAssist Pro drafts all these documents automatically at claimassistpro.com.

Question 2

How long does the insurer have to respond to a GRO complaint?

Accepted Answer

Under IRDAI (Protection of Policyholders' Interests, Operations and Allied Matters of Insurers) Regulations, 2024, the insurer must acknowledge your grievance within 3 days and resolve or communicate a final decision within 15 days.

Question 3

Is ClaimAssist Pro free to use?

Accepted Answer

Yes — it is free to start. You pay a 15% success fee only if your claim is actually settled. If we don't win, you owe nothing.

Question 4

Can I use ClaimAssist Pro for health, life, and motor insurance claims?

Accepted Answer

Yes. ClaimAssist Pro covers health insurance (including cashless denials and pre-existing disease rejections), life insurance (repudiation, nominee disputes), motor insurance (own damage and third-party), and home insurance claims.

Question 5

My Star Health insurance claim was rejected. What should I do?

Accepted Answer

Star Health commonly rejects claims citing pre-existing conditions, non-disclosure, or document discrepancies. You can file a GRO complaint to gro@starhealth.in within 15 days of rejection, then escalate to the IRDAI Ombudsman if unresolved. ClaimAssist Pro auto-drafts the GRO letter citing the exact IRDAI regulations that apply to your rejection reason.

Question 6

My Care Health (Religare) insurance claim was rejected. What are my options?

Accepted Answer

Care Health Insurance rejections can be challenged via their GRO at gro@careinsurance.com. Common rejection reasons like document discrepancy, direct admission without OPD, or lack of justification for hospitalization are contestable. File a GRO complaint with supporting documents. If Care Health doesn't resolve it in 15 days, escalate to the IRDAI Ombudsman — decisions are binding and free.

Question 7

LIC rejected my life insurance claim. Can I appeal?

Accepted Answer

Yes. Under Section 45 of the Insurance Act 1938, a life insurance policy cannot be questioned by LIC after 3 years from date of issuance on almost any ground. If your policy is over 3 years old and LIC has rejected the claim, this protection likely applies. File a GRO complaint first, then escalate to the IRDAI Ombudsman. ClaimAssist drafts the appeal citing Section 45 automatically.

Question 8

What is the IRDAI Insurance Ombudsman and how do I file a complaint?

Accepted Answer

The Insurance Ombudsman is a free, independent authority that resolves disputes between policyholders and insurance companies. There are 17 Ombudsman offices across India. You can file online at cioins.co.in/Complaint/Online. The process is completely free, requires no lawyer, and decisions are legally binding on the insurer. Claims up to ₹50 lakh are covered. ClaimAssist Pro prepares your complete Ombudsman complaint package.

Question 9

Can I go to Consumer Court for a rejected insurance claim?

Accepted Answer

Yes. Under the Consumer Protection Act 2019, a wrongful insurance claim rejection is a 'deficiency in service' and can be filed in Consumer Court. District Forum handles claims up to ₹50 lakh, State Commission up to ₹2 crore, and National Commission above that. You have 2 years from the date of rejection to file. No lawyer is mandatory. ClaimAssist drafts the full petition with supporting legal citations.

Question 10

My health insurance claim was rejected for pre-existing disease. Is this legal?

Accepted Answer

Not always. Under IRDAI Master Circular 2024, insurers can only reject for non-disclosed pre-existing conditions within the first 5 years (60 months) of the policy. After 5 years, the moratorium kicks in and the insurer cannot reject on this ground. Additionally, conditions that were disclosed at the time of policy issuance cannot be used as grounds for rejection. ClaimAssist analyses your specific situation against these rules.

Question 11

How do I write a GRO appeal letter for a rejected insurance claim?

Accepted Answer

A GRO appeal letter should include: your policy number and claim number, the specific rejection reason cited by the insurer, the IRDAI regulation or legal provision the rejection violates, supporting documents, and a clear demand for reconsideration within 15 days. ClaimAssist Pro generates this letter automatically in under 2 minutes based on your specific case — visit claimassistpro.com to get started for free.

Question 12

My Niva Bupa (formerly Max Bupa) health insurance claim was rejected. What can I do?

Accepted Answer

Niva Bupa (Max Bupa) rejections are most commonly for pre-existing conditions, non-disclosure, or non-network hospital admissions. Email their GRO at grievance@nivabupa.com within 15 days of the rejection letter. Mention the specific rejection reason and cite IRDAI regulations. If unresolved, escalate to the Insurance Ombudsman. ClaimAssist Pro drafts the complete appeal package automatically.

Question 13

Bajaj Allianz rejected my insurance claim. How do I contest it?

Accepted Answer

Bajaj Allianz claim rejections can be appealed by filing a GRO complaint at bagic.in/grievance or emailing bagicgro@bajajallianz.co.in. Common contestable grounds include insufficient investigation, violation of IRDAI processing timelines, or rejection on pre-existing condition grounds beyond the moratorium period. ClaimAssist Pro identifies which regulations support your case and drafts the GRO letter.

Question 14

HDFC Life rejected my life insurance claim. What are my options?

Accepted Answer

HDFC Life rejections can be challenged via GRO complaint at grievanceredressal@hdfclife.com. For life insurance policies over 3 years old, Section 45 of the Insurance Act 1938 provides strong protection against repudiation. HDFC Life must prove the policyholder intentionally misrepresented facts — a very high legal bar. ClaimAssist Pro drafts the Section 45-grounded appeal automatically.

Question 15

SBI Life rejected my term insurance claim. What should I do?

Accepted Answer

SBI Life commonly rejects term insurance claims citing non-disclosure of health conditions at the time of proposal. File a GRO complaint at sbilife.co.in/grievance within 15 days. If the policy is more than 3 years old, Section 45 of the Insurance Act prevents SBI Life from questioning the policy on almost any ground. ClaimAssist Pro drafts the full appeal citing these protections.

Question 16

ICICI Lombard rejected my health or motor insurance claim. What can I do?

Accepted Answer

ICICI Lombard rejections for health, motor, or home insurance can be appealed to their GRO at customersupport@icicilombard.com. For motor claims, common rejection grounds like 'driver under influence' or 'vehicle modification' must be proven by ICICI Lombard — the burden of proof lies with the insurer. Health claim rejections citing pre-existing conditions are contestable after the moratorium period.

Question 17

New India Assurance rejected my claim. How do I file a complaint?

Accepted Answer

New India Assurance is a public sector insurer governed by the same IRDAI regulations. File a GRO complaint at newindia.co.in or at your nearest branch's Grievance Redressal Cell. If unresolved within 15 days, escalate to the IRDAI Ombudsman. Being a government insurer, their decisions are often conservative — many rejections are overturned on appeal.

Question 18

My cashless hospitalization request was denied. Can I get reimbursement?

Accepted Answer

Yes. A cashless denial does not affect your right to file a reimbursement claim after discharge. Pay out of pocket, collect all original bills and discharge summary, and submit a reimbursement claim within 30 days of discharge. If the reimbursement claim is also rejected, file a GRO complaint within 15 days. ClaimAssist Pro handles both cashless escalation (before discharge) and reimbursement appeals.

Question 19

How long do I have to appeal a rejected insurance claim in India?

Accepted Answer

You should file a GRO complaint within 15 days of receiving the rejection letter (though IRDAI does not strictly bar later complaints). The Insurance Ombudsman must be approached within 1 year of the insurer's final rejection. Consumer Court petitions must be filed within 2 years of the rejection date under the Consumer Protection Act 2019. Act quickly — delays weaken your case.