{"id":5885,"date":"2026-10-12T01:05:27","date_gmt":"2026-10-12T06:35:27","guid":{"rendered":"https:\/\/www.coveryou.in\/blog\/?p=5885"},"modified":"2026-10-12T01:05:27","modified_gmt":"2026-10-12T06:35:27","slug":"indemnity-claim-rejected-what-to-do-doctor","status":"publish","type":"post","link":"https:\/\/www.coveryou.in\/blog\/indemnity-claim-rejected-what-to-do-doctor\/","title":{"rendered":"Your Claim Was Rejected. Now What?"},"content":{"rendered":"

The letter is two paragraphs long.<\/p>\n

It uses the word repudiated, cites a clause number, and does not explain itself.<\/p>\n

You have paid premiums for nine years and you are now, apparently, on your own.<\/p>\n

Not yet. Indemnity claim rejected what to do doctor<\/strong> questions have a defined answer in India, and the route has four steps with real deadlines attached.<\/p>\n

First, Get The Ground In Writing<\/strong><\/p>\n

Before anything escalates, make the insurer commit to its reasoning. Ask for the specific ground, the clause relied on, and the documents the decision was based on.<\/p>\n

Then test it honestly against your own file. Most repudiations of doctors\u2019 indemnity claims turn on a small number of grounds: a matter predating the retroactive date<\/a>, a known circumstance at inception<\/a>, non-disclosure<\/a>, work outside the declared scope, or costs incurred without consent.<\/p>\n

If the stated ground does not actually fit your facts, you have something to escalate. If it does, you may still have something to argue about materiality.<\/p>\n

Step One: The Grievance Redressal Officer<\/strong><\/p>\n

Once you know the ground, the escalation is procedural. Doctors asking indemnity claim rejected what to do doctor<\/strong> usually assume the next stop is a lawyer. It is not; it is a letter.<\/p>\n

Every insurer has one, and this step is not optional \u2014 it is the precondition for everything after it.<\/p>\n

Submit your representation in writing with the documents, and get a written acknowledgement. Insurers are expected to resolve a grievance in roughly a fortnight; published sources state fourteen days in one place and fifteen in another, so work to the shorter one and diarise it.<\/p>\n

Step Two: Bima Bharosa<\/strong><\/p>\n

If the insurer does not resolve it, the complaint goes to IRDAI\u2019s grievance portal, Bima Bharosa<\/a>, formerly IGMS. There is also a toll-free line on 155255.<\/p>\n

Be clear about what this is. Bima Bharosa tracks and escalates grievances to the insurer. It does not adjudicate your claim and it cannot award you money. It matters because it creates a record and applies pressure, not because it decides anything.<\/p>\n

Step Three: The Insurance Ombudsman<\/strong><\/p>\n

This is the step with real teeth, and the one doctors most often miss the deadline for.<\/p>\n