Health insurance claim appeals · India
They rejected your claim in four lines.The law gives you three ways to fight back.
Almost nobody uses them — not because they cost money (they are free), but because the process is procedural, intimidating and written in legal English. Ladai reads your rejection letter, finds the clause they leaned on, and builds a cited appeal you file yourself.
What we have read so far
- 100
- Insurance Ombudsman awards, indexed and tagged
- 120
- documents in the corpus
- 8
- ombudsman centres across India
- 15+
- insurers' rejection patterns
The ladder that already exists
You do not need a lawyer, and you do not need to pay a success fee. India already gives you a free, three-rung escalation. Ladai's job is to make each rung climbable.
- 01
The insurer's Grievance Redressal Officer
Every insurer must have one, and must respond. This is where a well-argued appeal — with the right clause and the right regulation quoted back at them — often ends the fight before it starts.
- 02
Bima Bharosa
IRDAI's own grievance portal. Your complaint is logged against the insurer and tracked by the regulator. Free.
- 03
The Insurance Ombudsman
Free, and the award binds the insurer — not you. Decisions are published, which is precisely why a corpus of past awards can tell you how strong your case is before you file.
Start with the reason on your letter
Insurers reject in patterns. We have tagged every document in the corpus against those patterns — here are the first two, with more landing as we publish them.
T01 · 38 documents tagged to this reason
“Pre-existing disease not disclosed”
This is the reason insurers reach for most often — 38 of the 120 documents we have indexed turn on it. It is also the one they most often cannot prove. The test is not whether you had the condition; it is whether you knew about it and consciously concealed it when you filled in the proposal form.
Arguments that have beaten this →T04 · 22 documents tagged to this reason
“Hospitalisation was not justified”
Second most common in our corpus, and the one where the outcome is least obvious. These cases turn on a single question, and it is not whether a doctor advised admission. It is: what treatment were you actually given while you were in there?
Arguments that have beaten this →
Eight more rejection reasons are being written up from the corpus.
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