Introduction
A rejected insurance claim does not necessarily mean that the policyholder must immediately begin court proceedings. India's insurance grievance framework provides mechanisms through which eligible disputes may be addressed before approaching formal litigation.
The Insurance Ombudsman is one such mechanism and is intended to provide an accessible and cost-effective forum for eligible complaints against insurers and intermediaries.
Start With the Insurer
The policyholder should first obtain the insurer's written decision and understand the exact reason for rejection. Relevant policy documents, correspondence and supporting evidence should be preserved.
IRDAI also provides a grievance escalation mechanism where a policyholder is dissatisfied with the insurer's response.
Ombudsman or Court?
The appropriate remedy depends upon the nature of the dispute, the policyholder's circumstances and the relief sought. The Insurance Ombudsman framework is intended to resolve specified complaints in a cost-effective manner, while consumer proceedings and other legal remedies may be available depending upon the facts.
Conclusion
The important lesson is strategic: a rejected claim should first be analysed, not simply accepted or immediately litigated. Understanding the available grievance mechanisms can help a policyholder choose the most appropriate remedy.
