Do you have the rejected insurance claims? Want to fight against your valid claim? Then you are at the right place.
Here, You’ll see what to do if an insurance company (like Star Health Insurance Company) rejects the valid claim.
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Get the Claim Rejection or Repudiation Letter
Claim Rejection
The claim rejection happens when the company directly rejects the claim without asking for any additional documents.
In this case, you need to get the claim rejection letter from the company.
Claim Repudiation Letter
The claim repudiation happens when the company asks for additional documents to process the claim.
And after checking the documents, the company rejects the claim.
In this case, you need to get the claim repudiation letter from the company.
Step 1: Complaint to Grievance Department of Insurance Company
Every company has a Grievance Department. The Grievance Department checks the quality and service-related issues.
You can contact them If you are not satisfied with their service or product.
You can contact them for the claim rejection as well.
You can contact them on their portal or you may get their emails on their websites.
Simply get the email and contact them by sending all your claim details.
Where to get the Grievance contact details?
You can simply search for “{COMPANY NAME} Grievance” on Google.
E.g. I search for “star health insurance Grievance” on Google and I get the website https://www.starhealth.in/grievance-redressal/
What are the Grievance Levels?
After visiting the Grievance page you will see multiple levels.
E.g. The Star Health Insurance Grievance Redressal has 4 levels.
Where do I need to contact Grievance?
First, You need to contact their Level 1.
Star Health Insurance has 3 ways to contact their first-level Grievance:
- The contact details of the Grievance officer of the policy servicing office. (The PDF list of Grievance officers)
- The contact details of the Grievance officer (Coordinator) of your ZO/AO. (The PDF list of Grievance officer (Coordinator))
- The Office Locator
Note: If the above PDFs are broken then please visit https://www.starhealth.in/grievance-redressal/
How much time do I need to wait after sending an email to Grievance?
You need to wait a maximum of 15 days. But it may depend on the insurance company.
The Grievance team will check your details and contact you back on your email and reply as per your details.
You may get all those details from their website.
Complaint to Grievance Level 2
If your query is not resolved from Level 1 then you can reach Level 2.
Note: Don’t contact Level 2 if you have not contacted Level 1.
You can get the details of Level 2 on their Grievance portal.
E.g. Star Health Insurance Level 2 provides:
- If you are not satisfied with our Zonal Grievance Coordinator’s response then Feel free to call us at our Sales & Services 044 6900 6900.
- Or, Submit the form online from https://www.starhealth.in/grievance-redressal/
After submitting the details, You may get some feedback.
If you don’t get those then you can reach the Level 3.
Step 2: Complaint to IRDAI
The full form of IRDAI is the Insurance Regulatory and Development Authority of India.
The IRDAI is a regulatory who watches on Insurance Companies.
Same as the RBI watch on the Indian Banks and the IRDAI watch on insurance companies.
Where to register a complaint in IRDAI?
You can register the complaint in 2 ways.
Register a complaint with a phone call
You can contact on 155255 or 1800 4254 732 and register your complaint.
Or,
Register a complaint from the online portal
Alternatively, You can visit https://bimabharosa.irdai.gov.in/ and register your complaint.
What to do after registering the complaint on IRDAI?
After registering the complaint you will get the token number.
You can keep your token to track your complaint in the future.
The IRDAI contact the insurance company and you will get a reply within 15 days.
If you do not get then you can go to the next step to Insurance Ombudsman
Step 3: Complaint to Insurance Ombudsman
The Insurance Ombudsman or Bima Lokpak is an independent platform where you can contact and share your complaint.
You can file a complaint and submit all the details.
There are 17 Ombudsman Centres, covering the country, situated in Ahmedabad, Bengaluru, Bhopal, Bhubaneswar, Chandigarh, Chennai, Delhi, Guwahati, Hyderabad, Jaipur, Kochi, Kolkata, Lucknow, Mumbai, Noida, Pune, and Patna.
See the list of all Insurance Ombudsman Addresses
Or, Visit https://www.cioins.co.in/Ombudsman
When I can complain to the Insurance Ombudsman?
You can complain to the Insurance Ombudsman if:
- Your claim was delayed by the Insurance company
- Your claim was deducted some claim amount by the Insurance company
- Your claim was rejected by the Insurance company
- Misuse of terms and conditions by Insurance company
Before registering the complaint to the Insurance Ombudsman
Fulfill Condition 1: Must contact Level 1, 2, and IRDAI.
You need to first complain to the Insurance Company.
You can find the above steps to reach Level 1 and Level 2 and IRDAI.
After that, you can contact the Insurance Ombudsman.
Fulfill Condition 2: Claim rejected not more than 1 year
If your claim is rejected by an Insurance company for 1 or more years then you can’t complaint on the Insurance Ombudsman.
Fulfill Condition 3: Claim amount less than 30 Lakhs
If your claim amount is more than 30 lakhs then you can’t complain on the Insurance Ombudsman.
Fulfill Condition 4: Not registered any court case
If you file the legal case for the claim in any court then you can’t complain on the Insurance Ombudsman.
How to register complain on the Insurance Ombudsman?
You can file a complain with 3 ways.
- File a complaint from an online portal to the Insurance Ombudsman
- File a complaint from the post office to the Insurance Ombudsman
- File a complaint from the local office to the Insurance Ombudsman
Method 1) File a complaint from an online portal to the Insurance Ombudsman
You can follow below steps:
- Visit to the URL https://cioins.co.in/Complaint/Online
- Enter the mobile number
- Fill the details
- Attach the documents
- And submit your complaint
Method 2) File a complaint from the post office to the Insurance Ombudsman
You can follow below steps:
- Visit ombudsman centres
- Find the nearest Ombudsman Center address
- Write the complaint and send to their address
After sending the letter, you will get the reply with ANNEX-VI-A.
E.g.
The letter will include the details of the document which you need to send to them.
Fill out the form and submit all necessary documents.
Method 3) File a complaint from their local office to the Insurance Ombudsman
Visit the ombudsman centers and check which office is near to you.
You can physically visit their office and submit your complaint.
What happens after registering the complaint with the Insurance Ombudsman
The Insurance Ombudsman will schedule the meeting within 1 month with the Insurance company.
In front of the Insurance Ombudsman, you can share all the details of your claim, submitted documents, and all other details as well.
And you will either get the claim or your claim will reject by the Insurance Ombudsman.
What happens if my claim is rejected by the Insurance Ombudsman?
If your claim is rejected by the Ombudsman then you can appeal for the next step.
But, The Insurance company can’t file a complaint against you in court.
Amazing 🙂
Step 4: Filing a Court Case Against Insurance Company
Most of the claims are settled in Step 3. If your claim is rejected by the Insurance Ombudsman then you are still able to file a court case against the insurance company.
- Visit to your nearest Court
- Find an Advocate who is experienced in claim insurance case
- Do the needful as per the guidance
The advocate may charge you some percentage of the claim amount.
Or, May some fixed amount.
Before proceeding further, discuss it and then continue on it.