1. Get the rejection in writing, with reasons
Demand the specific policy clause relied upon — "as per policy terms" is not a reason. You cannot fight what is not written down.
2. Match the reasons against your policy
Read the exclusions, waiting periods and disclosure conditions actually printed in your policy document. Many rejections cite clauses that do not apply to your facts — note each mismatch.
3. Appeal to the insurer’s Grievance Redressal Officer
Every insurer must have a GRO. File a written appeal with your evidence (discharge summary, bills, doctor's notes) and keep the acknowledgement. Give them the mandated response window before escalating.
4. Escalate to IRDAI
If unresolved, register the complaint on IRDAI's Bima Bharosa grievance portal or its toll-free helpline 155255. The regulator's entry alone often changes the insurer's tone.
5. Go to the Insurance Ombudsman
The Ombudsman is free, lawyer-optional and binding on the insurer up to the prescribed monetary limit — check the current limit and your city's office at cioins.co.in. File within one year of the insurer's final reply.
6. Consumer Commission as the further step
Wrongful rejection is a deficiency of service — the consumer forum route remains open, especially for larger claims. See our consumer refund guide for how that process runs.