Health Claim Denied? The Legal & Practical Recovery Playbook
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.
Step 2: Internal grievance (GRO)
File a formal complaint with the insurer's Grievance Redressal Officer with supporting documents. The insurer must respond within 15 days. This is the mandatory first step before external escalation.
What not to do
Do not accept the first rejection at face value, do not miss the GRO window, and do not discard medical records or hospital bills - they are your appeal evidence.
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.
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.