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Insurance Claim Rejection Appeal

An insurance claim rejection appeal is a written request asking your insurer to review and reverse its decision to reject, or repudiate, your claim.

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To, [insurer_name] Subject: Appeal against rejection of claim under Policy No. [policy_number] Dear Sir/Madam, I refer to your letter [rejection_reference], rejecting my claim under Policy No. [policy_number] on the ground that: [rejection_reason_stated]. I wish to appeal this decision on the following grounds: [appeal_grounds] I request that you reconsider my claim in light of the above, failing which I shall be constrained to approach the Insurance Ombudsman or the appropriate Consumer Disputes Redressal Commission for relief. [policyholder_name]

Insurance Claim Rejection Appeal: what it is

An insurance claim rejection appeal is a written request asking your insurer to review and reverse its decision to reject, or repudiate, your claim. It quotes the insurer's rejection letter and the reason given, sets out why that reason is wrong, and warns that you will approach the Insurance Ombudsman or a Consumer Commission if the claim is not reconsidered.

When you need this document

  • Your health insurer rejected a hospitalisation claim citing a pre-existing disease you had never been diagnosed with.
  • A motor claim was denied on a technical ground such as late intimation even though the loss is genuine.
  • A life insurance death claim was repudiated alleging non-disclosure in the proposal form.
  • The rejection letter gives a vague reason and you need to contest it formally before going to the Ombudsman.

What it covers

  • The insurance company as addressee, with the policy number in the subject line.
  • A reference to the insurer's rejection letter and its date.
  • The reason the insurer gave for rejecting the claim, as stated in its letter.
  • Your grounds of appeal, explaining why the rejection is wrong.
  • A request that the insurer reconsider the claim.
  • Notice that you may approach the Insurance Ombudsman or the Consumer Disputes Redressal Commission.

How to fill, sign and use it

  1. Read the rejection letter alongside your policy wording and find the exact clause the insurer relied on.
  2. Collect evidence that answers that clause, such as a treating doctor's certificate, hospital records, a survey report or past premium receipts.
  3. Fill in the form on this page, replying to the insurer's reason point by point rather than in general terms.
  4. Send it to the insurer's grievance redressal officer by email and post, and also register it on the insurer's grievance system or IRDAI's Bima Bharosa portal to get a complaint number.
  5. If the insurer rejects the appeal, does not reply within a month, or replies unsatisfactorily, approach the Insurance Ombudsman within one year of the insurer's decision.
  6. Keep copies of everything sent and received, with dates, for use before the Ombudsman or a Commission.

Documents to attach or keep with it

  • Copy of the policy schedule and policy wording
  • The insurer's rejection or repudiation letter
  • Claim form and the documents submitted with the claim
  • Medical records, survey report or other evidence answering the rejection reason
  • Premium payment receipts

The law behind it

Insurers are regulated by the Insurance Regulatory and Development Authority of India under the IRDAI Act, 1999 and the Insurance Act, 1938, and IRDAI's regulations require every insurer to run a grievance redressal system. If the insurer does not resolve your grievance, the Insurance Ombudsman Rules, 2017 let you complain to the Ombudsman free of charge. A wrongly rejected claim can also be challenged as a deficiency in service before a Consumer Commission under the Consumer Protection Act, 2019. For life policies, section 45 of the Insurance Act restricts repudiation once the policy has run three years.

Common mistakes to avoid

  • Arguing in general terms that the rejection is unfair without answering the specific clause cited.
  • Not supplying documents the insurer asked for earlier, which is often why the claim was rejected.
  • Going straight to the Ombudsman without a written complaint to the insurer, which the Ombudsman rules require first.
  • Signing a discharge voucher for a reduced amount 'in full and final settlement' without recording your objection.

Insurance Claim Rejection Appeal: frequently asked questions

How do I approach the Insurance Ombudsman after a claim is rejected?

First complain to the insurer in writing. If it rejects the complaint, does not reply within a month, or you are not satisfied with the reply, you can approach the Ombudsman for your area within one year. Complaints can be made online or by post, there is no fee, and you do not need a lawyer.

Can I file a consumer case if my insurance claim is rejected?

Yes. Wrongful repudiation of a valid claim is treated as a deficiency in service under the Consumer Protection Act, 2019. The complaint goes to the District, State or National Commission depending on the value involved, and should be filed within two years of the rejection. Choose either the Ombudsman or the Commission for the same dispute.

What is the time limit to challenge an insurance claim rejection?

There is no single deadline for writing back to the insurer, so check your policy wording and act quickly. The Ombudsman must be approached within one year of the insurer's final decision on your complaint. A consumer complaint must be filed within two years of the cause of action.

Can an insurer reject a claim for non-disclosure of an illness?

It can if the illness existed, was material and was not disclosed in the proposal form. It should not do so where the condition was unrelated to the claim, unknown to you, or already disclosed. For a life policy that has run three years, section 45 of the Insurance Act bars the insurer from calling the policy in question on any ground.

Last updated 3 October 2026.

General information on Indian law, not legal advice for your situation. Stamp duty, registration and fees differ by state, so check with the local office or an advocate before you rely on it.

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