If a claim is rejected, paid only in part or delayed, start with the insurer: the rejection letter must give the reason and the policy clause. You can then complain to the insurer, escalate to IRDAI through Bima Bharosa, and approach the Insurance Ombudsman free of charge.
Last reviewed on 18 October 2026. Exact requirements depend on your policy, the insurer and the rules in force.
Who this guide is for
- Policyholders, claimants, nominees and legal heirs
- Life, health, motor and other personal or small-business policies
Step by step
- Read the reason and the clause in the rejection letter, and compare it with your policy wording.
- Write to the insurer's grievance officer with your reasons and documents; keep the acknowledgement.
- If the insurer does not resolve it within two weeks, or you disagree with its reply, register the complaint on Bima Bharosa or with IRDAI's grievance cell.
- If the insurer has not replied within 30 days, or you are not satisfied, complain to the Insurance Ombudsman for your area within one year of the rejection — for claims up to ₹50 lakh.
- Courts and consumer commissions remain open; the Ombudsman does not take a case already before another forum.
Documents commonly asked for
| Document | Why it is needed |
|---|---|
| The rejection or settlement letter | Shows the reason and clause you are disputing. |
| Copy of all pages of the policy | The Ombudsman asks for it. |
| Your complaint to the insurer and its reply | Shows you went to the insurer first. |
| Old policies for the last 48 months, if the reason is a pre-existing disease or waiting period | Shows continuous cover. |
| All other letters with the insurer, broker or TPA | The full record of the case. |
The insurer may ask for fewer or other documents depending on the case.
Common mistakes
- Skipping the insurer and going straight to the Ombudsman
- Missing the one-year limit for the Ombudsman
- Paying someone who promises to get the claim approved
What the rules say
- Insurers are to acknowledge a complaint immediately and resolve it within 14 days. [1]
- The Ombudsman takes complaints free of charge, within one year of the rejection, for claims up to ₹50 lakh, after you have complained to the insurer. [2]
- The insurer is to comply with an Ombudsman award within 30 days; for each day of delay it owes the complainant ₹5,000, unless it has appealed. [1]
Rules referred to
- IRDAI Master Circular on Protection of Policyholders' Interests, 2024 (IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 September 2024)
Complaint handling, claim timelines for life, health and general insurance, Ombudsman awards. - Insurance Ombudsman Rules, 2017 (as amended) and the Council for Insurance Ombudsmen procedure (cioins.co.in)
Who can complain, the one-year limit, the ₹50 lakh limit and the documents to attach.
Finobazaar read published copies of these rules on 19 October 2026. Rules change: check the current text on irdai.gov.in or with your insurer.
Important limitations
- Finobazaar cannot decide or represent a complaint; this guide explains the official routes.
- This guide explains the usual process; it does not replace your policy wording or the insurer's instructions.
- Following these steps does not guarantee that a claim will be paid.
Official resources
- How to make a complaint (IRDAI) (opens in a new tab)Complain to the insurance company first. If it does not resolve the complaint within two weeks, or you are not satisfied, escalate to IRDAI.
- Bima Bharosa – IRDAI grievance portal (opens in a new tab)Register and track a complaint against an insurer after you have complained to the insurer.Toll-free 155255 or 1800 4254 732; email complaints@irdai.gov.in. IRDAI accepts complaints from the policyholder or claimant, not from agents or other people writing for them.
- Council for Insurance Ombudsmen (opens in a new tab)A free complaint to the Insurance Ombudsman when the insurer has not resolved your complaint. Claims up to ₹50 lakh.
- How to complain to the Insurance Ombudsman (opens in a new tab)Who can complain, time limits, documents to attach and how to file online, by email or by post.
Addresses checked on 19 October 2026.
Related
- Claim rejection follow-up checklistPapers to collect before you complain to the insurer, IRDAI or the Insurance Ombudsman.
- Policy exclusions: what insurance does not coverWhere to find exclusions in a policy and how to read them.
- Waiting periods in health insuranceInitial, pre-existing disease and specific illness waiting periods, and how continuity helps.
- How to make a health insurance claimCashless or reimbursement: which route to take and what happens at each step.