You’ve been paying your premiums every month. Without fail. Like clockwork.
Then the unthinkable happens. Someone you love ends up in the hospital. You’re scared. You’re exhausted. The last thing you want to think about is money.
But then your phone buzzes. An email. Two words that make your stomach drop:
“Claim Rejected.”
The anger hits first. Then the helplessness. Then the crushing question: What now?
Let’s figure this out together.
First, Know Your Claim Types
There are two ways to file a health insurance claim:
Cashless Claim: The dream scenario. You walk into a network hospital, flash your health card, and the hospital talks to your insurer directly. You only pay for what’s not covered. Simple. Clean. No massive bills.
Reimbursement Claim: The hard way. You pay everything upfront. Every single rupee. Then you gather mountains of paperwork: bills, receipts, discharge summaries, prescriptions, and send them to your insurer. And wait. And hope they pay you back.
When Rejection Hits: Your Battle Plan
Your claim got rejected. Cashless or reimbursement, doesn’t matter. You got the letter. The email. The “No.”
Here’s what you do. Step by step. Fight by fight.
Step 1 & 2: Don’t Give Up on the First “No”
Cashless claims get rejected for the most ridiculous reasons:
- Missing paperwork from the hospital
- Filed an hour too late
- The insurer’s doctor decided it “wasn’t an emergency”
- They want to investigate more
Here’s the truth: That first rejection isn’t final.
Your move? File a reimbursement claim immediately.
Yes, it’s painful. Yes, you have to pay the bill yourself. Arrange the money somehow. Borrow if you must.
But here’s the thing: many claims rejected at the cashless stage get approved for reimbursement. Why? Because now you can submit everything. Complete documentation. No rushing. No errors.
Pay the bill. Get every single document. Original discharge summary. Every lab report. Proper pharmacy bills (not just scribbled totals). Submit it all.
Still rejected? Now we fight harder.
Step 3: Call in the Grievance Officer
You paid. You submitted everything. They still said no.
Time to escalate.
Every insurance company has a Grievance Redressal Officer (GRO). It’s literally their job to handle complaints like yours.
How to reach them:
- Check your insurer’s website for the “Grievance Redressal” section
- Or go directly here: https://www.cioins.co.in/GRONonLife
What to say: Write a clear, firm email. No begging. No anger. Just facts.
- Your policy number
- Your claim number
- The rejection reason they gave
- Why they’re wrong
- Any proof you have—policy clauses, documents, anything
Create a paper trail. You’ll need it later.
Some companies have two levels. If Level I ignores you (or doesn’t respond in 15 days), escalate to Level II.
Give them 30 days maximum. If they don’t fix it—or if their answer is garbage—it’s time to go nuclear.
Step 4: Report to the “Principal” (Bima Bharosa)
The insurance company isn’t listening? Fine. Let’s bring in the regulator.
Bima Bharosa (https://bimabharosa.irdai.gov.in/) is the official complaint portal. Run by IRDAI—the Insurance Regulatory and Development Authority of India.
Think of it like this: You complained to the teacher. They ignored you. Now you’re going to the principal.
When you file here, the regulator knows about it. That puts real pressure on your insurer. They have to respond. Officially. On record.
Step 5: Bring in the Referee (Ombudsman)
This is your power move. And it’s completely free.
The Insurance Ombudsman is an independent authority. They don’t work for the insurance company. They work for fairness.
When to go:
- Your insurer ignored your grievance for 30+ days
- OR you got a response, but it was useless
- AND Bima Bharosa didn’t help either
How to file: Find your regional Ombudsman office (there are offices across India) or file online at https://www.cioins.co.in/
What happens: They review everything. Both sides. Then they make a decision. If you accept it, the insurance company must comply. By law.
This step has real teeth.
Step 6: The Nuclear Option (Consumer Court)
If everything—and I mean everything—has failed, you still have one weapon left.
Consumer Court.
You paid for a service. They denied it unfairly. You’re a consumer, and you have rights.
This step takes longer. You might need a lawyer. But it’s your fundamental right to fight for what you’re owed.
This is your last resort. Your final stand.
You’re Not Alone in This Fight
I won’t lie to you. This process is exhausting. It’s frustrating. There will be days you want to give up.
Don’t.
Protect yourself:
- Keep every single document. Every bill. Every email. Every letter.
- Document every phone call. Write down names, dates, what was said.
- Read your policy. I know it’s boring as hell. But take one hour and understand what you actually paid for.
You held up your end. You paid those premiums month after month after month.
Don’t let them steal that money with a single “No.”
You have a voice. You have a path. You have rights.
Walk it. Fight it. One step at a time.
You’ve got this
