A complaint letter for a rejected claim.
A short, factual letter to the insurer’s Grievance Redressal Officer is the first formal step, and you will need it for the Ombudsman later. Here is a simple format you can adapt.
Before you write
- Find the Grievance Redressal Officer’s email in your policy document, on the insurer’s website, or in the insurer’s letters.
- Have the claim number, policy number and the date of the rejection or settlement letter ready.
- Note the exact words of the insurer’s reason and the clause it cites, if any.
A format you can adapt
To: The Grievance Redressal Officer, [insurer name] Subject: Complaint about claim no. [claim number], policy no. [policy number] Dear Sir or Madam, I am writing about claim no. [claim number] under policy no. [policy number], for the treatment of [patient name] at [hospital] from [date] to [date]. By your letter dated [date], the claim was [rejected / settled for ₹[amount] against ₹[amount] claimed]. The reason given was: “[the insurer’s exact words]”. I disagree with this decision because: 1. [Your first point, the fact behind it and the document that shows it] 2. [Your second point] [If no clause was cited:] Your letter does not refer to the specific policy terms it relies on, as IRDAI’s Master Circular on Protection of Policyholders’ Interests, 2024 requires. Please review the claim and pay ₹[amount], with interest as due under IRDAI’s rules. Please also send me [a copy of my proposal form / the itemised claim settlement sheet]. I attach: [rejection letter, policy schedule, discharge summary, bills]. If this is not resolved, I will approach the Insurance Ombudsman. Yours faithfully, [Name, phone, email]
How to send it
- Keep the letter to one page, stick to facts and dates, and number your points.
- Email it to the Grievance Redressal Officer with the attachments, and keep the sent email.
- Note the date. The insurer must acknowledge immediately and resolve the complaint within 14 days.
- If the insurer rejects it, doesn’t reply within one month, or you’re not satisfied, go to the Insurance Ombudsman within one year.
Questions people ask
Who should I address the complaint to?
The insurer’s Grievance Redressal Officer. Their contact details are in your policy document, on the insurer’s website and usually in the insurer’s letters.
How long does the insurer have to reply?
It must acknowledge immediately and resolve the complaint within 14 days, giving reasons with reference to the policy terms if it doesn’t accept it.