Health Insurance Claim Rejected? Your 2026 Fight-Back Plan
File a formal complaint with the insurer's Grievance Redressal Officer with supporting documents. The insurer must respond within 15 days. This is the mandatory first step before external escalation.
What not to do
Do not accept the first rejection at face value, do not miss the GRO window, and do not discard medical records or hospital bills - they are your appeal evidence.
Step 3: Insurance Ombudsman
If the GRO reply is unsatisfactory, file with the Insurance Ombudsman - free, semi-judicial, and binding on the insurer. Acknowledgment in 3-5 working days, awards typically within 3 months.
Claim recovery specialists handle appeals through GRO, IRDAI and the Ombudsman, and have recovered over Rs 50 crore for families. See the health insurance claim rejection fight-back guide for free guidance.