Health Claim Denied? The Legal & Practical Recovery Playbook
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 4: IRDAI Bima Bharosa (IGMS)
File on the Bima Bharosa portal at bimabharosa.irdai.gov.in to put regulatory pressure on the insurer. A trackable reference number is issued and the insurer must respond within 15 days.
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.
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.