Delayed claim · Penal interest
Health insurance claim not settled on time? Your right to interest and how to claim it
A claim that sits “under review” for months is not just frustrating. Insurers are expected to settle within a fixed time, and delay can attract interest.
By the MediclaimSaathi team Updated 8 November 20266 min read
Quick answer
Under IRDAI’s policyholder-protection rules, an insurer is expected to settle or reject a claim within 30 days of receiving the last necessary document. If it pays late without a lawful reason, you can ask for interest at 2% above the bank rate for the delay. Note the date your last document was received, ask for the claim status in writing, and send a grievance to the Grievance Redressal Officer that states the amount, the dates and the interest you are claiming. If there is no resolution in 30 days, go to Bima Bharosa and the Insurance Ombudsman.
The settlement timeline
| Stage | What to know |
|---|---|
| Cashless | Decision within 1 hour of the request; final discharge authorisation within 3 hours. |
| Reimbursement | Settlement or rejection is expected within 30 days of the last necessary document. Check your insurer’s current timeline in its customer charter. |
| Delay without reason | You can claim interest at 2% above the bank rate for the period of delay. |
| Piecemeal queries | Insurers should ask for all missing documents together, not one query after another. |
How to claim the delay interest
- 1Fix your datesWrite down the date each document was submitted and the date the last one was acknowledged. Keep emails and portal receipts.
- 2Ask for status in writingAsk the insurer or TPA for the current status and the reason for the delay.
- 3Count the daysCount from the receipt of the last necessary document to the payment date or today.
- 4Send a grievanceState the claim amount, the dates, the days of delay and that you claim interest at 2% above the bank rate.
- 5EscalateAfter 30 days with no resolution, register on Bima Bharosa and, within one year, file with the Insurance Ombudsman.
Mistakes that weaken a delay claim
- No proof of when documents were submitted. Always get an acknowledgement.
- Answering queries by phone only. Reply in writing and keep copies.
- Waiting for months before writing. Send a grievance as soon as the timeline is crossed.
- Accepting part-payment without noting that you reserve your claim for the rest and for interest.
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Check my letter freeFrequently asked questions
What is the time limit for a health insurance claim settlement?+
The insurer is expected to settle or reject within 30 days of the last necessary document for reimbursement. Cashless requests have shorter limits: 1 hour for the request and 3 hours for discharge.
How much interest can I claim for a delayed claim?+
Interest at 2% above the prevailing bank rate for the delay period, where the delay has no lawful reason.
What if the insurer keeps raising new queries?+
Insurers should ask for missing documents together. Reply in writing, keep proof, and mention the repeated queries in your grievance.
Can the Ombudsman order interest?+
The Insurance Ombudsman can award relief on a valid complaint, including interest where applicable. Ask for it in your complaint.
Related guides
Sources
- IRDAI — Master Circular on Health Insurance Business (May 2024)
- IRDAI Bima Bharosa grievance portal
- Council for Insurance Ombudsmen
This guide is general information, not legal advice. Rules change; always check the current IRDAI circulars and your policy wording. MediclaimSaathi is a document-preparation platform, not a law firm, insurer or broker.