An insurance policy is a contract of utmost good faith — and that obligation binds the insurer as much as the insured. When a genuine claim is repudiated or cut down, the policyholder has structured remedies. The chamber of Advocate Manish Jha advises on and litigates such disputes in Delhi.
Common Grounds of Repudiation
Insurers typically reject claims citing non-disclosure of pre-existing disease, breach of policy conditions, delay in intimation, exclusion clauses, or discrepancies in the surveyor's assessment. Each ground must be tested against the policy wording, the proposal form and the actual facts — repudiation letters often state conclusions that the record, when read as a whole, does not support. The chamber begins by calling for the complete claim file.
The Grievance Ladder
- Insurer's grievance cell — a written complaint to the insurance company's grievance redressal officer is the first step, and creates the record for later forums. The IRDAI's grievance framework, operated through its Bima Bharosa portal, tracks such complaints and requires time-bound responses.
- Insurance Ombudsman — for personal-lines claims within the prescribed monetary ceiling, the Insurance Ombudsman offers a cost-free forum under the Insurance Ombudsman Rules, 2017. The complaint should ordinarily be brought within one year of the insurer's final rejection.
- Consumer commissions — wrongful repudiation is a deficiency in service under the Consumer Protection Act, 2019. Complaints are filed before the District, State or National Commission according to the value claimed, generally within two years of the cause of action.
Surveyor Reports in Property and Fire Claims
In fire and other property claims, the surveyor's report carries significant weight but is not the last word: an assessment can be challenged where it is unreasoned, ignores documents or is contradicted by the material on record. Policyholders should preserve all correspondence, photographs and books of account from the moment of loss.
Motor third-party claims follow a separate track before the Claims Tribunals — see the motor accident claims and MACT practice pages. Health-claim disputes often overlap with medical negligence issues.
Frequently Asked Questions
What can I do if my insurance claim is rejected?
First obtain the repudiation letter and complete claim file, then lodge a written grievance with the insurer's grievance redressal officer. If that fails, the Insurance Ombudsman offers a free forum for eligible personal claims, and the consumer commissions under the Consumer Protection Act, 2019 can award compensation for wrongful repudiation.
What is the time limit to challenge a repudiation?
A complaint to the Insurance Ombudsman should ordinarily be filed within one year of the insurer's final reply, and a consumer complaint within two years of the cause of action. Because limitation generally runs from the repudiation, prolonged correspondence with the insurer should never be allowed to consume the limitation period.
Is the surveyor's report binding on me?
No. A surveyor's assessment is important evidence but not conclusive. It can be contested where it is unreasoned, overlooks documents, applies wrong policy terms or is internally inconsistent. Forums can and do award amounts different from the surveyor's figure when the record justifies it, so the report should be scrutinised closely.
Can a claim be rejected for delayed intimation alone?
Insurers do cite delay, but a genuine claim supported by proof of loss should not fail on a purely technical delay where the delay is explained and causes the insurer no prejudice. Each case turns on the policy wording and facts, which is why the full claim file should be examined before accepting a rejection.