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Insurance Desk not Processing Claim: What to Do Next
Reviewed on: 2026-05-30.
30-Second Answer
If insurance desk not processing claim, collect the account, application, transaction, policy, property, employee, pension, scholarship or bill reference and send one precise written complaint to the office that can correct the record or release the money. Ask for a written reason if the request is refused or kept pending. Escalate with the same evidence bundle to hospital billing desk, medical records department, insurer desk and consumer forum. Use RTI only for records held by a public authority: file movement, deficiency notes, dispatch records, sanction details, payment advice, inspection reports or reasons recorded on file.
Where to escalate
Use the correct external forum. Use National Medical Commission or the other official source linked below where it fits the subject. For consumer-service disputes, consider National Consumer Helpline and e-Daakhil. For public departments, CPGRAMS, state grievance portals and RTI may help. For high-value or time-sensitive cases, take professional advice before limitation expires.
Official Sources
What should I do first if insurance desk not processing claim?
Preserve proof, write a dated complaint with reference numbers, and ask for a written decision or correction instead of relying on calls.
Related Guides
Insurance desk not processing claim: How to escalate and time limits under IRDAI rules?
When the insurance company's desk is not processing your claim, here is the complete escalation guide:
- Step 1: IRDAI time limits for claim processing. (a) cashless health insurance: the TPA must approve/deny within 3 hours of receiving the request, (b) reimbursement health insurance: the insurer must settle within 30 days of receiving all documents, © life insurance death claim: settle within 30 days (120 days if investigation required), (d) motor insurance: settle within 30 days of survey, (e) if the insurer delays beyond these limits: they must pay interest at 2% above the bank rate.
- Step 2: Common delays. (a) the insurer asks for documents repeatedly, (b) the TPA does not respond, © the claim is “under review” with no timeline, (d) the insurer disputes the claim without giving reasons, (e) the hospital insurance desk does not forward the cashless request to the TPA.
- Step 3: Escalation within the insurer. (a) first: file a written complaint with the insurer's grievance officer, (b) the grievance officer must respond within 15 days, © if not resolved: escalate to the insurer's Chief Grievance Officer, (d) keep all reference numbers and correspondence.
- Step 4: IRDAI escalation. (a) if the insurer does not resolve within 30 days: file a complaint with IRDAI ( Integrated Ombudsman), (b) file online at: bima-sevak.in or [email protected], © the Ombudsman can award up to Rs 50 lakh (including compensation), (d) the Ombudsman's award is binding on the insurer (but not on you — you can go to court).
- Step 5: Insurance desk at hospital. (a) if the hospital insurance desk is not processing: (i) ask for the TPA reference number, (ii) call the TPA directly, (iii) call the insurer's helpline, (b) if the desk refuses to process cashless: (i) get the rejection in writing, (ii) pay and keep bills, (iii) file for reimbursement, © if the desk is unresponsive: complain to the hospital administration.
- Step 6: Consumer complaint. (a) if the insurer denies the claim without valid reason: file a consumer complaint (deficiency in service), (b) the Consumer Protection Act 2019 allows complaints up to Rs 50 lakh at District Commission, Rs 50 lakh-2 crore at State Commission, © limitation: 2 years from the date of denial.
- Step 7: File RTI. File RTI with IRDAI asking for: (a) the number of claim delays reported, (b) the penalty imposed on insurers for delayed claims, © the average claim settlement time by insurer.