The insurer said no. Now what?
A rejection letter is the start of a process, not the end of it. Send us a photo. We read it free.
An honest answer either way, even when the answer is “don't fight this.”
“Why was my claim even rejected?”
Non-disclosure
A condition the form never mentioned, often filled in by an agent, not you.
Room-rent & sub-limits
One wrong room, and the whole bill shrinks in proportion.
Documentation gaps
A missing summary, an illegible discharge sheet, a late intimation.
“Policy interpretation”
The insurer reads an exclusion widely. Readings can be challenged.
Most rejections stand on one of these four. None of them is automatically the final word.
“Is mine worth fighting?”
That's the first thing we answer, free, from two photos: the letter and your policy schedule.
If it isn't worth fighting, we say so. That honesty is the service.
About half
of the Insurance Ombudsman's awards go the policyholder's way.
Rejections are opinions. Opinions get overturned.
“Where does a fight actually go?”
1
The insurer’s grievance cell
We file in writing. A statutory 15-day clock starts. Most weak rejections die here.
2
Bima Bharosa
IRDAI’s grievance portal. Your complaint now sits on the regulator’s desk, not the insurer’s.
3
The Insurance Ombudsman
Free for you. The award is binding on the insurer. This is where about half of fought cases are won.
“And what does this cost me?”
The assessment: free. If we fight: a small registration fee, agreed before we start.
After that, a success fee, only once the claim is approved.
Where a case needs specialist representation, we bring in empanelled claim experts. One point of contact: us.
Asked by people holding this letter
What we need from you, what the common rejection grounds really mean, and what it costs.
Two photos on WhatsApp: the rejection letter and your policy schedule. That is enough for an honest first read. If the case needs more (discharge summary, bills, the proposal form) we will tell you exactly which documents, one list, once.
Not necessarily. Non-disclosure is the most common rejection ground. And one of the most challengeable, especially when an agent filled your form, the condition was unrelated to the claim, or the policy has run past its contestability window. This is exactly the kind of letter worth sending us.
Pay-and-file is not defeat. A cashless denial is only a decision about pre-authorisation. You can still claim reimbursement for the same treatment, and many denials reverse on paper. Since 2024, IRDAI has also restricted the old room-rent proportionate deductions, so bill cuts that once looked final are increasingly challengeable.
The assessment is free, always. If your case is worth fighting and you engage us, a small registration fee agreed before we start, then a success fee only once the claim is approved. Where a case needs specialist representation, we bring in empanelled claim experts, but you deal with one point of contact: us.
We will say so, plainly, and for free. And we will show you what in your policy caused it. So your next policy does not carry the same trap. Telling you the truth when there is no fee in it is the whole point of this practice.
The only fixed clock is statutory: once we file with the insurer's grievance cell, they have 15 days to respond. Beyond that, timelines depend on the forum: Bima Bharosa moves in weeks, the Ombudsman in months. We tell you where your case stands at every stage; we do not invent deadlines we cannot control.
Send the letter. We'll tell you the truth.
Two photos on WhatsApp. A free, honest read. Then you decide.
Sources
- 1.“About half”: Council of Insurance Ombudsmen, Annual Report 2023-24. Adjudicated awards favouring the policyholder.
- 2.The 15-day window: the insurer grievance-redressal timeline under IRDAI's policyholder-protection framework.
- 3. Room-rent deduction limits: IRDAI Health Insurance Master Circular, 2024.
Rejected-claim support is a flat-fee service; the assessment is free.