If a life insurance claim is rejected, then you must first understand the cause of rejection. Before taking any further action, you need to go through your case and documents carefully. You must also review the terms and conditions governing the life insurance policy. If there is any discrepancy, you can take further action.
Let us understand some of the methods or steps for handling rejection of your life insurance claim.
Discussion with the insurer
Before lodging a complaint about your denial, you can have a concrete discussion with the representative of your insurance company. You can let him know that your claim has been rejected. This will make the insurer to review your case in a detailed manner. In this way, your complaint can be resolved earlier.
Clarification for reasons of claim denial
There may be certain omission in your life insurance claim documentation. You should clarify the reasons and rectify the loopholes immediately. But if your claim is rejected for some other reason, then you can go for appealing your claim. You can surely ask for a detailed explanation about the same.
When time matters….
You must reply to the insurer’s correspondence within the timelines specified. You must not be lethargic. You should always respond to the queries raised by the insurer. This is because many of the insurance companies have specified timelines for claiming the life insurance amount. The time limitation is an important concern for you.
Arbitration
You are not satisfied with your claim amount or your insurer has straightway declined your claim without a valid reason. You have an option to go for arbitration to settle the disputes.
Careful record-keeping
You should always keep a record of the persons whom you talked to regarding your insurance claim rejection. Also specify the date, what was promised and what was decided during the conversation. You must do this for every personal meeting and even for phone calls. This will help you to approach later for litigation or arbitration.
Appeal process
If you feel that your life insurance claim is rejected without a good reason, then you must acquire knowledge about the appeal process. You must check the instructions for filing an appeal against the insurer. Most importantly, take care of the time limitation period for appeal filing.
Internal Review:
In the meantime, you must review your documentation. Have a meeting with your doctor and confirm whether the doctor has provided the right information. If there is an error on the part of the doctor’s staff, then fix it immediately and resubmit the documents to the insurer’s office.
File an appeal
If the insurance company does not care about your request and still refuses to pay the claim, you have every right to file an appeal with your insurer, who will be called for an internal review to submit their decision and supporting documents on the case.
Seek the help of Ombudsman
The financial ombudsman offers independent and free service, investigating the complaint you raised against the financial institution. They will hear both sides of the story, cross check the documents and come to a fair conclusion. If they find right on your side then the insurance company will be called to explain their action, apologise and pay compensation.
IRDA Links and Guidelines
- If you have grievance, approach the grievance cell of the Insurance Company first.
- If you are not happy with their solution, you can escalate the matter to IRDA
- How to make a complaint?
- Complaint Logging at IRDA
- Integrated Grievance Management System – By IRDA
- IRDA – Updated list of Life Insurers
- IRDA – Updated list of Non-Life Insurers
