IRDAI Grievance Letter Generator (Free Preview)

To, The Principal Grievance Redressal Officer (GRO), Star Health and Allied Insurance Grievance Redressal Department Subject: Formal Grievance under IRDAI Regulations against Wrongful Repudiation / Disallowed Claim No. [Claim Number] Policy Number: [Policy Number] Claim Number: [Claim Number] Insured Patient Name: [Patient Full Name] Treating Hospital: [Hospital Name] Date of Decision / Repudiation Letter: 25 October 2026 Claimed Amount: ₹2,50,000 Disputed / Disallowed Amount: ₹1,85,000 Dear Sir / Madam, 1. I am writing to lodge a formal statutory grievance against the wrongful decision conveyed vide your communication dated 25 October 2026, wherein my health insurance claim has been repudiated / subjected to arbitrary deductions amounting to ₹1,85,000. 2. GROUND OF DISPUTE: The primary reason cited for repudiation / deduction is "Pre-Existing Disease (PED) / Non-Disclosure". I submit that this decision is factually flawed, medically unsustainable, and in direct contravention of the binding regulations framed by the Insurance Regulatory and Development Authority of India (IRDAI). 3. FACTUAL AND LEGAL SUBMISSIONS: (a) The ailment leading to hospitalization had acute onset during the active policy period and was not an existing pre-diagnosed condition at the time of inception. (b) Under IRDAI Master Circular (29 May 2024, Cl 6.1), the maximum permissible statutory waiting period for pre-existing disease is capped at 36 months, which has been fulfilled. (c) Under Section 45 of the Insurance Act 1938 and IRDAI Moratorium guidelines, post 60 continuous months of coverage, no policy can be questioned on grounds of non-disclosure except proven deliberate fraud. 4. STATUTORY CITATIONS AND REGULATORY PROVISIONS: The repudiation / deduction directly violates the following statutory mandates: • IRDAI Master Circular on Protection of Policyholders' Interests 2024 (Clause 6.1 & 6.2) • Section 45 of Insurance Act, 1938 (Incontestability of Policy) 5. JUDICIAL PRECEDENT: The Supreme Court of India and Consumer Dispute Redressal Commissions have repeatedly ruled against arbitrary repudiations. Specifically: • Supreme Court of India in Manmohan Nanda v. United India Assurance Co. Ltd., (2022) 4 SCC 582 — Insurers cannot mechanically repudiate claims once underwriting has concluded without strict proof of fraudulent concealment. 6. RELIEF SOUGHT: In light of the documentary evidence and established law, I hereby request your office to: (i) Immediately recall and reverse the wrongful repudiation / deductions on Claim No. [Claim Number]; (ii) Process and disburse the outstanding disputed amount of ₹1,85,000 directly to my bank account via NEFT; (iii) Pay penal interest at the rate of two percent (2%) above the prevailing bank rate from the date of claim submission until realization, as mandated under Regulation 16 of the IRDAI (Protection of Policyholders' Interests) Regulations 2024. 7. NOTICE OF ESCALATION: Please note that under Clause 11.2 of the IRDAI Master Circular 2024, your office is mandated to formally resolve this grievance within thirty (30) calendar days from receipt of this representation. If this matter is not satisfactorily resolved within 30 days, I shall proceed without further notice to: 1. Register a regulatory escalation token on the IRDAI Bima Bharosa Portal (bimabharosa.irdai.gov.in); and 2. Lodge a formal complaint before the Hon'ble Insurance Ombudsman under Rule 13 & 14 of the Insurance Ombudsman Rules 2017 for award and compensation. Enclosures: 1. Copy of Rejection / Deduction Letter dated 25 October 2026 2. Copy of Health Insurance Policy Schedule 3. Hospital Discharge Summary and Treating Doctor's Certificate 4. Final Itemized Hospital Bill and Payment Receipts Yours faithfully, [Your Full Name] Contact: [Your Mobile Number & Email Address] Date: 6 November 2026