Answer Book question
The rejection letter citing the specific policy clause; the claim file number; and the insurer's grievance escalation details. With those three things you can respond to the actual reason rather than a verbal summary, and escalate to the regulator's portal and the Ombudsman if needed.
The rejection letter citing the specific policy clause; the claim file number; and the insurer's grievance escalation details. With those three things you can respond to the actual reason rather than a verbal summary, and escalate to the regulator's portal and the Ombudsman if needed.
A claim is rejected "for non-disclosure." The written letter reveals the alleged non-disclosure is a hospitalisation twelve years earlier for an unrelated fracture. The family produces discharge records showing no ongoing condition. The grievance cell reverses the rejection within a month.
A rejection must state the ground. Common grounds: non-disclosure, waiting period, exclusion, non-medical-necessity, documentation. Each has a different response. The escalation ladder is grievance officer, Bima Bharosa (IRDAI), Insurance Ombudsman.
The clause cited Whether the cited ground is factually accurate Documents that rebut it: proposal form, medical records, prior claims Timelines for each escalation step
Accepting a TPA phone call as the final word. The TPA is not the insurer's last decision-maker.
The Ombudsman office serving Kerala accepts complaints without a lawyer. Kerala Rising can help assemble the file.
Rejection month 1 → written reason month 1 → grievance reply month 2 (reversed). Total time: seven weeks. Without the written reason, the family would have had nothing to rebut.
If the rejection is for a genuine waiting-period or exclusion clause that applies, escalation rarely succeeds. Read the clause first.
Request the written rejection with clause Assemble rebuttal documents Escalate on schedule
The insurer rejected our death claim. What can we do? Why did insurance pay only part of my hospital bill?
Health, disability & life events
IRDAI health insurance regulations and consumer guidance · Your policy wording and schedule · Karunya Arogya Suraksha Padhathi (KASP) / PM-JAY guidelines for whether you may qualify Rates, limits and whether you may qualify change. Confirm with the official source. Ask Kerala Rising: Send us the policy schedule and the ages of everyone covered. We will tell you what the policy actually pays, what it does not, and whether a large bill would be survivable. WhatsApp +1 443 595 9000 · keralarising.com Kerala Rising › Money › Health insurance · Health 15
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