Health Claim Denied? The Legal & Practical Recovery Playbook
For life policies, Section 45 of the Insurance Act 1938 bars contest after 3 years of continuous coverage except for proven fraud - a powerful lever on older claims.
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.
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.