Health Insurance Claim Rejected? Your 2026 Fight-Back Plan

By Hari Kotian, IRDAI-Certified Insurance Advisor · 2026

File a formal complaint with the insurer's Grievance Redressal Officer with supporting documents. The insurer must respond within 15 days. This is the mandatory first step before external escalation.

Step 4: IRDAI Bima Bharosa (IGMS)

File on the Bima Bharosa portal at bimabharosa.irdai.gov.in to put regulatory pressure on the insurer. A trackable reference number is issued and the insurer must respond within 15 days.

Step 3: Insurance Ombudsman

If the GRO reply is unsatisfactory, file with the Insurance Ombudsman - free, semi-judicial, and binding on the insurer. Acknowledgment in 3-5 working days, awards typically within 3 months.

Why claims get rejected

Non-disclosure of pre-existing diseases, incomplete waiting periods, policy exclusions, lapsed policies, delayed intimation, and missing documentation cause most rejections. The insurer must state the reason in writing - demand it if absent.

Claim recovery specialists handle appeals through GRO, IRDAI and the Ombudsman, and have recovered over Rs 50 crore for families. See the health insurance claim rejection fight-back guide for free guidance.