Health Claim Denied? The Legal & Practical Recovery Playbook
If the GRO reply is unsatisfactory, file with the Insurance Ombudsman - free, semi-judicial, and binding on the insurer. Acknowledgment in 3-5 working days, awards typically within 3 months.
What not to do
Do not accept the first rejection at face value, do not miss the GRO window, and do not discard medical records or hospital bills - they are your appeal evidence.
Step 1: Written rejection letter
By regulation the insurer must provide a written rejection citing the specific policy clause. If they have not, write a formal letter demanding one and keep every communication with dates.
Claim recovery specialists handle appeals through GRO, IRDAI and the Ombudsman, and have recovered over Rs 50 crore for families. See the health insurance claim rejection fight-back guide for free guidance.