3 Alternatives If Your Life Insurance Claim Gets Rejected

We purchase life insurance with the hope that we get the necessary benefits on time when the need arises. Whether it is a death benefit claimed by the nominee, the maturity benefit or a rider claim, we all want swift and hassle-free settlement of our claim. But sometimes, due to some factors, our insurance claim can be rejected and this phase can be harrowing and frustrating for the person making the claim.There are many reasons for a rejected insurance claim, like misunderstanding the terms and conditions, ignorance on the policyholder’s part, furnishing incorrect information or non-declaration of certain factors and even a delay in claiming the insurance. But even when your claim is rejected, you must not panic. Because there are systems put in place that specifically help people during such circumstances. A rejected claim is not the final chapter. You have many options that you can take to ensure that your application is reviewed and scrutinised once again.Before we look at the options that you can take when your claims are rejected, let us look at the type of claims that a person can make.

A death claim is made by the nominee in the event that the policyholder passes away during the policy tenure. This claim is usually made by a family member that the insured person chose originally as the nominee.

Some insurance plans like endowment plans and Unit Linked Insurance Plans offer a cash benefit when the policy matures, and the policyholder survives the policy tenure. The insured person themselves can make this claim and there are very low chances of such a claim being rejected.

A rider is an additional benefit over a life insurance policy . For eg. you can opt for a critical illness or an accidental benefit rider, wherein your insurance provider will pay you the assured sum in case you suffer from a critical illness or an accident.

Approach your insurance provider

When your claim is rejected, you must first understand why it was rejected. To know that you have to approach your insurance provider. Get all details regarding your claim rejection and study them carefully. Find out whether the coverage you claimed was mentioned in the exclusions list or whether it was covered in your plan.Do your research and find out whether the rejection was a fair process or whether you feel you’ve been taken advantage of. If you feel the rejection was unfair, you can make a formal complaint to the insurance company, citing all details and reasons why you feel your claims as unfairly rejected. Your insurer can then review your file and make a decision.

Escalate your case to the IRDAI

If you’re not happy with your insurer’s response to your complaint, you can approach the Insurance Development and Regulatory Authority of India . You can file a complaint with the Grievance Redressal Cell of the Consumer Affairs Department by calling them on 1800 4254732 or 155255, emailing your complaint at complaints@irda.gov.in, or using their online portal to register your complaint.
Additionally, you can also physically mail a filled-out complaint registration form align with a written complaint letter to:General ManagerConsumer Affairs Department- Grievance Redressal Cell,Insurance Regulatory and Development Authority of India (IRDAI)

Go to The Insurance Ombudsman

Insurance ombudsman is an official assigned by the government who can entertain insurance grievances. There are various offices set up across India and you can approach them if all of the above fails. To make your case stronger, you must submit all previous complaints and communications to the ombudsman. Also, the insurance ombudsman only accepts complaints where the claim amount is less than Rs. 30 lakhfor life insurance and Rs. 20 lakh for critical illness or other such claims.

Approach A Consumer Forum or The Courts

If you’re still not satisfied with any of the above options, you can always approach the court of law and file a case. This process may take a long time for a resolution because there is no time restriction. But all you have to do is keep your fingers crossed and wait for the judgement in your favour. The fact will be that you’re still fighting and that’s what matters.

Thus, one must not lose heart when their insurance claim is rejected. There are still plenty of options to resolve your claim and you can use the available machinery to help you achieve your insurance claim.

The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.