Answer Book question
Get the rejection in writing with the specific reason, because your options depend entirely on what that reason is. Then escalate in order: the insurer's grievance officer, IRDAI's Bima Bharosa portal, and the Insurance Ombudsman. Most rejections are about non-disclosure or lapsed premiums, and a surprising number are overturned when the family produces records the insurer did not have.
Get the rejection in writing with the specific reason, because your options depend entirely on what that reason is. Then escalate in order: the insurer's grievance officer, IRDAI's Bima Bharosa portal, and the Insurance Ombudsman. Most rejections are about non-disclosure or lapsed premiums, and a surprising number are overturned when the family produces records the insurer did not have.
An insurer rejects a ₹50 lakh term claim citing non-disclosure of hypertension. The family finds the proposal form: the agent had filled it in and ticked "no" to every health question without asking. The policy was more than three years old. Under the applicable provisions on contestability, the insurer's ability to repudiate on that ground was limited. The Ombudsman directed payment.
Insurers can repudiate for material non-disclosure, fraud, lapse, or an exclusion. Indian law limits the window in which a policy can be questioned on grounds of misstatement once it has run for a specified number of years. The claim process has three formal rungs: the insurer's internal grievance cell, the regulator's complaint portal, and the Ombudsman, whose award is binding on the insurer up to a monetary limit.
The exact written ground for rejection Policy age at the time of death and the contestability provisions The original proposal form. who filled it, what was declared Premium payment record. was the policy in force on the date of death Medical records that either support or contradict the insurer's claim
Silence is a choice the insurer benefits from. Families often accept a verbal rejection and stop. Ask for it in writing, keep every acknowledgment number, and move to the next rung within the stated timelines.
The Insurance Ombudsman has an office covering Kerala. Complaints can be filed without a lawyer. Kerala Rising can help you assemble the file; we cannot represent you.
Timeline in the case above: rejection letter month 1; grievance officer reply month 2 (upheld rejection); Bima Bharosa complaint month 2; Ombudsman hearing month 6; award month 7; payment month 8.
If the policy had genuinely lapsed for non-payment months before death, the claim is unlikely to succeed, though some insurers pay ex gratia in grace-period cases. If a material illness was knowingly hidden and the policy is young, the insurer is usually within its rights.
Obtain the written rejection with the specific ground Gather the proposal form, premium receipts and medical records File with the grievance officer, then escalate on the regulator's timeline
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Health, disability & life events · Family support
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