Insurance is a foundation of financial security in India. Yet, many policyholders face serious hardship when their claim is rejected by insurance companies especially during medical emergencies or after road accidents. A health insurance claim rejection or motor insurance claim rejected often happens when policyholders need support the most.
This blog explains why insurance claim rejected cases occur, the most common mistakes policyholders make, and the legal remedies available in India to resolve claim disputes effectively.
Why Insurance Claims Get Rejected in India
A claim rejected by insurance companies in India is usually based on technical, procedural, or disclosure-related reasons. Understanding these reasons is essential before taking corrective or legal action.
Health Insurance Claim Rejected: Common Reasons
Non-Disclosure of Pre-Existing Conditions
One of the most common reasons for health insurance claim rejected cases is non-disclosure of pre-existing illnesses such as diabetes, hypertension, or heart disease at the time of policy purchase.
Claims Raised During Waiting Period
Most health policies include waiting periods of 2–4 years for specific conditions. Claims made during this period result in health insurance claim rejection.
Incorrect or Incomplete Documentation
Missing hospital bills, incorrect patient details, or incomplete discharge summaries can lead to an insurance claim rejected, even if treatment was genuine.
Policy Lapse or Expiry
If premiums are unpaid or the policy has expired, the insurer is legally allowed to deny the claim.
Treatment at Non-Network Hospitals
Cashless claims are frequently denied when treatment is taken at hospitals not approved by the insurer.
Policy Exclusions
Cosmetic treatments, fertility procedures, and alternative therapies are excluded unless specifically mentioned in the policy.
Motor Insurance Claim Rejected: Common Reasons
Invalid Driving Licence or Drunk Driving
A motor insurance claim rejected is common if the driver does not possess a valid licence or was under intoxication at the time of the accident.
Delayed Accident Intimation
Failure to inform the insurer within the stipulated 24–48 hours often results in claim denial.
Repairing the vehicle before surveyor inspection violates claim procedures.
Commercial Use of Private Vehicle
Using a private vehicle for commercial purposes without endorsement invalidates the policy.
Insurance Not Transferred to New Owner
For second-hand vehicles, failure to transfer insurance ownership leads to insurance claim rejected outcomes.
Health Insurance Claim Rejected Help: Legal Remedies Available
A claim rejected does not mean the end of your rights. Indian law provides multiple redressal mechanisms for policyholders.
Grievance Redressal with Insurance Company
All insurance companies in India have a Grievance Redressal Officer (GRO). File a written complaint with supporting documents. The insurer must respond within 15 days.
Escalation to IRDAI
If unresolved, escalate the matter through IRDAI’s Bima Bharosa Portal, which oversees fair conduct by insurers.
Insurance Ombudsman
For disputes up to ₹30 lakh, policyholders can approach the Insurance Ombudsman for a free and time-bound resolution.
Consumer Court Litigation
When administrative remedies fail, policyholders can file a case under the Consumer Protection Act, 2019.
Here, VIVS LEGAL plays a crucial role by filing and representing insurance claim rejected cases before District, State, or National Consumer Commissions.
Preventive Steps to Avoid Insurance Claim Rejection
Read Policy Terms Carefully
Understand inclusions, exclusions, and waiting periods before purchasing insurance.
Honest Disclosure
Disclose all medical conditions, vehicle usage details, and modifications accurately.
Maintain Proper Documentation
Keep medical records, bills, FIRs, survey reports, and policy copies organized.
Timely Renewals
Avoid policy lapses by renewing premiums on time.
Use Authorized Facilities
Opt for network hospitals and authorized garages whenever possible.
Conclusion: Claim Rejected Is Not the End
A health insurance claim rejected or motor insurance claim rejected can be challenged successfully with the right approach. With regulatory oversight, legal forums, and consumer protection laws, policyholders in India have strong remedies against unfair practices by insurance companies in India.
At VIVS LEGAL, we assist clients whose insurance claim rejected cases deserve justice. We pursue insurers, file consumer litigation, and represent policyholders across legal forums to ensure rightful claims are honoured provided documents comply with policy terms.If your claim is rejected, timely legal action makes all the difference.
