Insurance guides

Reviewed on: 2026-08-25.

An insurance claim can fail at three points, and each failure has a different counter-move. It can fail after approval, when the insurer accepts the claim but the money never arrives; the IRDAI policyholder protection framework lets you demand interest at bank rate plus 2 percent on that delay. It can fail at the decision, when the claim is closed and nobody tells you; you demand the written closure grounds and push to reopen. And it can fail during processing, when the portal shows a document missing that you uploaded weeks ago; you build an evidence trail and refuse to play the endless deficiency game. This category has a dedicated guide for each of those three failures.

• The insurer's grievance officer first. Every insurer must run one. Complain in writing with policy number and claim number, and keep the acknowledgment — the steps above it are closed to you until this one is on record.
• Bima Bharosa — IRDAI's complaint portal. It registers your grievance against the insurer and tracks it to closure with the insurer's own response on record.
• The Insurance Ombudsman at cioins.co.in — free, for claims up to ₹50 lakh, covering delay, repudiation, mis-selling and service failures. It expects the insurer's reply or 30 days to have passed first.

Skipping a step does not speed things up; it resets them. A dated grievance-cell complaint plus a Bima Bharosa registration is the strongest possible ombudsman file.

• Health claims — including the two cashless traps: a denial because the hospital was quietly blacklisted, and a hospital demanding extra payment on top of an approved cashless amount. Keep the pre-authorisation, the final approval, every bill and the discharge summary; for the records side, see medical records guides.
• Property claims — such as a burglary claim closed with no explanation. The insurer's survey report is the document to demand; it is where silent repudiations hide.
• Motor and travel claims — repair estimates, salvage and surveyor notes decide these; ask for the surveyor's report in writing, not a phone summary.

LIC and the public sector general insurers answer RTI directly, so policy records, claim files and internal notes can be demanded from them under the RTI Act. Private insurers do not, but IRDAI does — and an RTI to IRDAI asking for the action taken on your Bima Bharosa complaint, with dates and the officer's name, is often what converts a languishing registration into a closure notice. That combination — regulator complaint plus action-taken RTI — is covered in the guides below.

At admission or loss, start a claim file and feed it same-day: the policy number and the insurer's claim registration number, every pre-authorisation and approval in writing, photographs where the loss is physical, bills with receipts, and the discharge or survey summary at the end. The pattern across every guide in this category is identical — claims that are documented in real time settle, and claims reconstructed after the fact become disputes. Forty-eight minutes of filing at the start saves forty-eight days of escalation later.

It varies by claim type and policy, but the insurer must communicate at every stage, and silence past the timeline is itself a complaint ground. Put dates on everything: request date, document date, last communication date. Interest claims for delay sit on those dates.

No. The grievance and Bima Bharosa routes are statutory protections, and retaliation is itself actionable. The documented complainant with a paper trail is the claimant insurers handle most carefully.

The insurer's own written communication — the approval SMS, the cashless authorisation, the surveyor's report. Ask for each in writing as it happens; reconstructing them a year later is how claims die.

The insurance ombudsman's award binds the insurer once you accept it; the insurer cannot appeal an award within the limits it accepts cases. That asymmetry is why a complete file matters — the award stage is where evidence, not argument, decides the outcome.

• Claim approved but payment delayed: demanding interest
• Claim closed without any communication: reopening it
• Claim document uploaded but shown as missing
• Cashless claim denied because the hospital was blacklisted
• Cashless claim approved but hospital demands extra payment
• Burglary insurance claim closed with no explanation
• Travel Insurance Claim Rejected? Fight Back
• Portability Reset Your Waiting Period Wrongly?
• Group Health Insurance Claim Rejected After Leaving the Job
• Insurance Desk not Processing Claim: What to Do Next
• Home Insurance Claim Rejected After Fire, Flood or Theft
• Health Claim Reopened Repeatedly: What to Do Next
• Travel Insurance Medical Claim Dispute: What to Do Next

Other problem areas are on the all practical guides page, and the records-first method behind every route here is in The RTI Playbook.