Insurance Grievance Letter Template India — Write to Your Insurer's GRO

To, The Grievance Redressal Officer [Full name of insurance company] [Company address — found on your policy document] By email: [GRO email address from the insurer's website] By post / courier: [address above] Date: [Date] Subject: Formal Grievance — Wrongful Rejection of Claim No. [CLAIM NUMBER] Policy No. [POLICY NUMBER] | Insured: [YOUR FULL NAME] Dear Sir/Madam, I write to formally grieve the rejection of my insurance claim under the above-referenced policy. 1. BACKGROUND I hold [type of insurance] policy No. [POLICY NUMBER] issued by [insurer name], with a sum insured of ₹[AMOUNT]. The policy has been continuously in force since [ORIGINAL INCEPTION DATE] and is currently valid until [EXPIRY DATE]. On [DATE OF HOSPITALISATION / INCIDENT], I [briefly describe what happened — hospitalised for X / vehicle damaged / insured died]. I filed claim No. [CLAIM NUMBER] on [DATE CLAIM FILED]. 2. THE REJECTION By letter / email dated [REJECTION DATE], [insurer name] rejected my claim on the stated ground that: "[QUOTE THE REJECTION REASON EXACTLY AS STATED]." 3. WHY THIS REJECTION IS INVALID [Choose and adapt the applicable argument:] For pre-existing condition rejections: The pre-existing condition exclusion does not apply because [choose one or more]: (a) The condition treated was not caused by the alleged pre-existing condition — the pre-existing condition must be the direct and proximate cause of treatment, not merely present in my medical history. (b) I have held this policy for [X] years, and the [X]-year PED waiting period has been fully served. (c) I was not aware of the alleged condition at the time of the proposal — it was first diagnosed during the current hospitalisation. For non-disclosure rejections: The non-disclosure ground fails because [insurer name] has not established all three required elements: (a) That the statement in the proposal was false; (b) That it was material to the underwriting decision; and (c) That it was made with fraudulent intent to deceive. [Specify which elements are not established and why.] For cashless / delay rejections: The denial of cashless pre-authorisation was invalid because [insurer name] / the TPA failed to respond within the 1-hour period mandated by IRDAI regulations. The pre-authorisation request was submitted at [TIME] and the response (if any) was received at [TIME] — a gap of [X] hours/minutes. For late intimation rejections: The rejection on grounds of late intimation is invalid. IRDAI regulations and Supreme Court precedent require the insurer to demonstrate actual prejudice caused by the delay — not merely that the delay occurred. No such prejudice exists in this case because [explain]. 4. APPLICABLE REGULATION [Choose the applicable regulation:] - IRDAI Health Insurance Regulations, 2016 (as amended) - Section 45, Insurance Act 1938 (for life insurance after 3 years) - IRDAI Motor Insurance Guidelines - IRDAI Travel Insurance Guidelines 5. RELIEF SOUGHT I respectfully request that you: (a) Review the rejection in light of the above; (b) Approve and settle the claim in full amounting to ₹[CLAIMED AMOUNT]; or (c) Provide a written, reasoned response within 15 working days as required under IRDAI Grievance Redressal Guidelines. I attach in support: - Rejection letter dated [DATE] - [List supporting documents: hospital bills, discharge summary, medical reports, policy document, etc.] If this grievance is not resolved within 30 days, I intend to file a complaint on IRDAI IGMS (igms.irda.gov.in) and escalate to the Insurance Ombudsman for [your region]. Yours faithfully, [FULL NAME] [ADDRESS] [MOBILE NUMBER] [EMAIL ADDRESS] [DATE]