Insurance Complaint Letter — IRDAI Bima Bharosa

How to file a IRDAI Bima Bharosa / Insurance Ombudsman complaint

1. 1

   Complain to the insurer's grievance cell first

   Email the insurer's Grievance Redressal Officer (every IRDAI-licensed insurer must have one). Get a complaint reference number. Save every reply.

2. 2

   Wait 15 days for a response

   IRDAI rules give insurers 15 days to resolve grievances. If they ignore you or refuse without sound reasons, you can escalate.

3. 3

   Generate the IRDAI letter with Nyaykar

   Tell Nyaykar what you bought, what was rejected, and why the rejection is unfair. The AI drafts a formal letter to IRDAI / Insurance Ombudsman quoting your policy clause, the IRDAI Health Insurance Regulations 2016 / 2024, and the rejection reason.

4. 4

   File on bimabharosa.irdai.gov.in

   Open Bima Bharosa, register, attach the policy, the rejection letter, and Nyaykar's complaint letter. Submit. You'll get a token number for tracking.

5. 5

   Insurance Ombudsman if needed

   If IRDAI's resolution doesn't satisfy you, escalate to the regional Insurance Ombudsman within 1 year. Awards up to ₹50 lakh are binding on the insurer.

Frequently asked questions

Is filing with IRDAI free?

Yes, completely free. So is filing with the Insurance Ombudsman. The only cost is your time — and the letter generation cost on Nyaykar (₹0 within your free quota).

What is the time limit to complain about a rejected claim?

1 year from the insurer's final rejection letter or 1 year from when you should reasonably have received it. Don't wait — older complaints can still be filed but evidence gets weaker.

Can I complain about an old policy that was mis-sold?

Yes. Mis-selling — agents who lied about returns, hid premium-payment terms, sold a ULIP as a fixed deposit — is a clear IRDAI violation. Mention specific things the agent said and any written / WhatsApp evidence.

What's the difference between IRDAI and Insurance Ombudsman?

IRDAI is the regulator — they handle policy/regulation breaches. Insurance Ombudsman is a separate quasi-judicial body for claim disputes up to ₹50 lakh. Most consumers go to IRDAI first via Bima Bharosa, then to the Ombudsman if unsatisfied.

Health insurance company says it's a 'pre-existing condition' — what now?

Insurers must list pre-existing conditions in your policy at the time of issuance. If they raised this defence after the policy was issued without proof you concealed something, that's a violation. The complaint letter Nyaykar drafts cites the relevant IRDAI Health Insurance Regulations.

Will IRDAI pay me back if the insurer is wrong?

IRDAI can direct the insurer to settle. The Insurance Ombudsman can issue a monetary award up to ₹50 lakh that is binding on the insurer. For larger claims, you'd go to a Consumer Commission (NCDRC for over ₹10 crore).