Your Rights in Insurance Disputes
If your insurance claim is denied, delayed, or unfairly settled, you are protected under the Insurance Act, 1938, the IRDAI (Protection of Policyholders’ Interests) Regulations, 2017, and the Consumer Protection Act, 2019.
1. Right to Timely Claim Processing
- IRDAI Rules: Claims must be acknowledged within 3 days, settled within 30 days after receiving the last document.
- Unjustified delays can be penalized, and interest is payable on delayed settlements.
2. Right to Escalate the Complaint
- Start with the insurer’s Grievance Redressal Officer (GRO).
- If unsatisfied, escalate to the Insurance Ombudsman (no lawyer required).
- You can also file a case in the Consumer Commission.
3. Common Issues You Can Challenge
- Health insurance claim rejection
- Vehicle accident insurance delays
- Life insurance settlement refusal
- Unjust policy lapse or deduction
- Disputes over claim amount or exclusions
4. Documents to Keep Ready
- Copy of the policy document
- Original bills, medical records, FIR (if applicable)
- Written claim and rejection letter
- Email or postal records with insurer
5. Legal Remedies
- Insurance Ombudsman: Fast, free process for claims under ₹30 lakh
- District/State/National Consumer Commissions: For higher-value disputes or where Ombudsman route fails
- Lawyers can assist in preparing the case, compiling evidence, and presenting arguments
6. Important Tip
Always read the policy exclusions and conditions. Do not sign blank claim forms. Keep copies of every document and interaction.