Escalation · Insurance Ombudsman

How to file an Insurance Ombudsman complaint for a health claim (free)

The Insurance Ombudsman is the fastest free way to fight an unfair health insurance decision in India. No lawyer, no fee, and hearings can be online.

By the MediclaimSaathi team Updated 3 November 20267 min read

Can you file? Check these first

• You sent a written complaint to the insurer first (its Grievance Redressal Officer).
• The insurer rejected it, did not reply within 30 days, or you are unhappy with the reply.
• It is within one year of the insurer’s final reply.
• The claim value is up to ₹50 lakh.
• The same dispute is not already in a court or consumer commission.

How to file, step by step

1. 1Collect your papersPolicy, claim and rejection letters, your grievance to the insurer and its reply (or proof it did not reply), hospital bills and discharge summary.
2. 2Write the complaintExplain the facts, the clause the insurer used, why it is wrong, and the amount you want. Keep it short and factual.
3. 3File online or by postUse the Council for Insurance Ombudsmen’s online complaint system, or post it to the Ombudsman office for your area.
4. 4Attend the hearingYou present your case yourself, often by video. The insurer is heard too.
5. 5Accept the awardIf you accept the decision, the insurer must comply. If you don’t, you can still go to a consumer commission.

Tips that make a difference

• Quote the insurer’s exact words and clause number, then answer each point.
• Use dates: policy start, renewals, porting, diagnosis, admission and the rejection.
• Attach the treating doctor’s certificate on medical necessity or the history of the illness.
• Ask for interest for the delay where applicable.

Frequently asked questions