Health Insurance Claim Denied
Your insurer refused to pay a claim you believe is valid.
What this generally means
Insurers must provide a valid, documented reason for denial, and denied claims can be appealed internally or escalated to the insurance regulator.
Your journey
You Are Here
You're trying to understand what to do about a denied insurance claim. That's a good first step.
Understand Issue
Read through what this situation generally means and what your options are.
Gather Documents
Collect the evidence and paperwork that will support your case.
Contact Resource
Reach out to the most relevant authority, helpline, or legal aid service.
Escalate If Needed
If the first contact doesn't resolve things, escalate to a higher forum or authority.
Follow Up
Track your complaint's status and keep records of every response you receive.
Common next steps
- 1Request the written reason for denial from your insurer.
- 2Reread your policy document for the specific exclusion cited.
- 3File an appeal with the insurer's grievance cell.
- 4Escalate to IRDAI's grievance portal if the appeal is also denied unfairly.
Useful documents
- Insurance policy document
- Claim denial letter
- Medical records related to the claim
- Hospital bills
Relevant authorities
- Insurance Regulatory Grievance Cell (IRDAI)
- Insurer's Grievance Cell
Frequently asked questions
Can I dispute a denial based on a 'pre-existing condition' clause?+
Yes, if you believe the condition was disclosed properly or doesn't meet the policy's definition, you can formally dispute it.
How long does an IRDAI complaint take?+
Timelines vary, but IRDAI generally requires insurers to respond to escalated complaints within a set period.
Verified resources
Bima Bharosa (IRDAI Grievance Portal)
IRDAI's Integrated Grievance Management System for complaints about denied or delayed insurance claims, including health insurance. Toll-free: 1800-4254-732 / 155255.
Ayushman Bharat (PM-JAY) Helpline
Toll-free helpline for beneficiaries facing issues with eligibility, empanelled hospitals, or claims under the government's PM-JAY health insurance scheme.
Local Patients' Rights NGO
Illustrative example only — this is not a specific real organization. Search for patient advocacy groups in your city, or file with your State Medical Council.