How to Appeal a Rejected Health Insurance Claim in India (2026)

By Hari Kotian, IRDAI-Certified Insurance Advisor · 2026

Non-disclosure of pre-existing diseases, incomplete waiting periods, policy exclusions, lapsed policies, delayed intimation, and missing documentation cause most rejections. The insurer must state the reason in writing - demand it if absent.

Section 45 advantage

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 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.

Step 1: Written rejection letter

By regulation the insurer must provide a written rejection citing the specific policy clause. If they have not, write a formal letter demanding one and keep every communication with dates.

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.