Health insurance claim rejected? Your grievance letter, filled in for you

What is a health insurance claim grievance?

A formal grievance to the insurer. It lists your policy and claim details, the reason the insurer gave, why that reason does not apply (with the IRDAI rule where one helps), and asks for a written reply with the policy clause relied on. It also says you will go to Bima Bharosa and the Insurance Ombudsman if needed.

When do you need a health insurance claim grievance?

• Your claim was rejected.
• The insurer paid much less than the bill without clear reasons.
• The claim has been pending for a long time.

Documents needed for a health insurance claim grievance

• The insurer's rejection or settlement letter.
• Discharge summary, final bill and payment receipts.
• A note from the treating doctor, if the reason is medical.
• Policy schedule and wording.

How to make a health insurance claim grievance: stamp paper, signing, submitting

1. Fill in the insurer, policy and claim numbers, and the reason the insurer gave.
2. Write in two or three lines why you disagree, in plain words.
3. Email it to the grievance address on the insurer's website or submit it at a branch; keep the complaint number.
4. If not resolved, escalate on bimabharosa.irdai.gov.in, then complain to the Insurance Ombudsman at cioins.co.in within one year of the insurer's reply.