• Chambers of Daksha Kumar

Legal remedies available to a person when his insurance claim is rejected

An insurance policy provides you with protection against any form of risk. It's a guarantee that you'll be compensated for your loss.


You can purchase a policy from a variety of insurance firms on the market. You must pay a regular premium, and they will compensate you in a lump sum in the event of any mishap.

You will be compensated for any damage based on your insurance policy. For example, if the policyholder dies in an accident or your home is burned in a tragic occurrence, you can file a claim for the insurance.


Who can claim insurance?

The individual who purchased the policy, the nominee, their heir, or any other person having a relationship with the policyholder who has been authorised by the court can claim the insurance.


The insurance can only be used if the damage occurs as a result of a misfortune. If the policyholder or a third party is proven to have falsified information, they may be fined and the policy may be revoked.


Reason for rejection of insurance claim

You get insurance to ensure that you will be able to survive in the event of an emergency or other unforeseen occurrence. You buy the insurance to pay your hospital bills on time or recover from misfortunes.


But what happens if your insurance claim is denied?

Your insurance company refused to help you during this difficult time. How are you going to sustain your family? Whom you will look for?


Well, your insurance claim may be denied in some circumstances, therefore you need to be cautious while purchasing an insurance policy. Let's have a look at some of the most common reasons:


• Not reading the terms and conditions thoroughly.

• When acquiring the policy, keep the crucial details hidden.

• Negligence on the part of the policyholder when the policy was being finalised.


Legal remedies for rejected insurance claim

The insurance claim can be denied no matter how carefully you purchased the policy or read all of the terms and conditions. And you're stumped as to what to do next.

There are, nevertheless, certain legal options for finding a solution. If your insurance claim is denied, you can take these.


Contact the Insurance Regulatory and Development Authority (IRDA), which is the specialised entity in charge of handling all insurance-related complaints. Provide all documents and information about your problem to the appropriate person.


Under Rule 12 of the Redress of Public Grievances Act of 1998, contact the Insurance Ombudsmen. An insurance ombudsman can act as a mediator between the policyholder and the insurer to resolve the dispute under section 12(1) (b).


If your complaint isn't handled through the first or second steps, you can go to a consumer forum. It is the last resort and can be time-consuming. Therefore, it is preferable to resolve the claim in the first or second approach.


Final thought

To avoid having an insurance claim denied, carefully read all of the terms and conditions before purchasing an insurance policy. Provide accurate information and follow all guidelines. However, if your claim is still rejected, you can always pursue legal action.

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