Insurance Claim Rejected? Key Steps Every Policyholder Must Know To Fight Back Invalid Claim Rejections

Eye-catching advertisements urging people to secure their financial future with health or life insurance often overlook a crucial reality, the growing issue of claim rejections. According to the Insurance Regulatory and Development Authority of India (IRDAI), health insurers in India rejected claims worth Rs 15,100 crore in the financial year 2023-24, exposing a critical gap between promise and protection.

In case of claim rejections, policyholders can reach out to their insurers for answers. If they are unsatisfied with the response, they can seek help from Bima Lokpal, or Insurance Ombudsman to review the situation.

How To Fight Back Against Invalid Claim Rejections?

While many claims are rejected on valid grounds, a huge chunk of health and life insurance claims are rejected by insurers for minor mistakes and technicalities, like missing out on name of hospital's name in the form, lack of some medical reports, etc. If a policyholder is not satisfied with the insurance provider's response on claim rejection, here's how they can file a complaint with Ombudsman.

What is Ombudsman?

An insurance ombudsman is a quasi-judicial authority to offer free, fast and neutral platform for resolving disputes arising between policyholders and insurance companies and intermediaries. The Insurance Ombudsman scheme was created by the government of India for individual policyholders. They can settle their complaints out of the court system under the scheme. As per the official website, there are around 17 Insurance Ombudsman in different locations.

Who Can File A Complaint With Ombudsman?

Any person who has a grievance against an insurer, may himself or through his legal heirs, nominee, or assignee, can make a complaint in writing to the Insurance ombudsman. The complainant must ensure that he/she reaches out to the ombudsman of related territory as per his/her residential address.

How To File A Complain Related to Claim Rejection?

The complaint can be filed with the office of Insurance Ombudsman. Petitioners must be mindful to choose the ombudsman based on their territory. The complaint can be filed only by the policyholders or not by any broker or insurance agent. Additionally, the complaint can be filed via legal hier, nominee or assignee either through a written complaint duly signed by him or through electronic mail or online through the online platform, ie www.cioins.co.in. Follow the below mentioned steps to register complaint online.

-Visit https://www.cioins.co.in/
-Go to home page, now select the option of 'Complaint online'.
-Select the option of 'Register Complaint' on the dropdown menu.
-Read the instructions carefully and enter the mobile number.
-Enter the OTP you will receive.
-A message will appear on your screen. Read it carefully and click on 'I agree'.
-Select between 'Insurance company' and 'Insurance broker' based on the complaint you wish to file against.
-Now, you will be required to share all the required details of the complainant, complain, upload necessary documents and sign declaration.
-Once, you have completed all the steps, proceed by clicking on the 'declaration'.
-Submit your complaint and take a screenshot for future reference.