Dealing with insurance claim-related issues in India can be challenging. From delay in
claim process to outright claim rejection, these disputes often leave policyholders frustrated
and without the financial support they need.
You are not alone. And the burden too, is not yours alone to carry.
In this guide, we'll cover three proven strategies to help you handle insurance claim disputes
in India with confidence.
1. Understanding Common Insurance Claim Disputes in India
Insurance claim disputes occur when there's a disagreement between the policyholder and the
insurance company regarding the terms of the insurance policy, the validity of a claim, or the
amount of compensation owed.
Common insurance claim-related issues include -
● Delay in claim process
● claim rejection
● Mis-selling of insurance policy
● Lapsed insurance policy
Knowing how to address these disputes effectively can make the difference between a denied
claim and a successful settlement.
Let us consider an example of Shakuntala Devi v. Metlife India Insurance Co. Ltd.
● The Case - Shakuntala Devi's claim for her late husband Ravinder Kumar's insurance
policy with Metlife India was rejected. The insurer cited a mismatch between
Ravinder's signatures on the insurance application and his PNB account form and
alleged he had concealed a cancer diagnosis.
● The Arguments - Shakuntala Devi argued that her husband's signature was authentic
and attested by a PNB official. She also claimed there was no evidence that her husband was suffering from cancer,
refuting the insurance company's assertions.
● The Verdict - The NCDRC ruled the claim rejection based on a signature mismatch
was unjustified and found no credible evidence of illness. It reinstated the original
decision, granting Shakuntala Devi the insurance payout with interest.
2. Top 3 Ways to Overcome Insurance Claim Disputes in India
1 - Documentation
The first step in overcoming claim rejection-related issues is ensuring you have all the
necessary documentation. This step isn't just about paperwork; it's about building a solid
foundation of evidence for your claim.
Here's what you need:
● Copy of Insurance Policy Document
● Receipts and Bills
● Photographic Evidence
● records of all communications with the Insurance Company
2 - Clear Communication with Your Insurance Company
Miscommunication can lead to insurance claim-related issues that could have been avoided
with a little clarity. Presenting your case clearly and maintaining open lines of
communication with your insurer can help you address any misunderstandings that may arise.
Your claim letter should clearly explain what happened, outline the type of claim, and
provide supporting documents. Think of it as telling your side of the story in a compelling yet
factual manner. Be concise and professional in your communication.
3- Be Ready to Appeal and Negotiate
Getting a claim rejection can feel like hitting a brick wall, but it's not the end of the road.
Consider it a detour rather than a dead end. be prepared to appeal the decision and then
negotiate.
● Understand the Denial: First, read the denial letter carefully. Understand the specifics
behind your claim rejection.
● File an Appeal: Draft a strong appeal letter that responds directly to the reasons for
the denial. Include any additional evidence that can support your claim.
● Negotiation is Key: Don't accept a low settlement without questioning it. Arm
yourself with the knowledge of your policy details and be prepared to discuss them
with your insurance company.
Conclusion
Have you faced insurance claim disputes? You might be surprised just how near help might
be hidden, and how a professional is waiting to help you through these trying times.
If you feel your claim is being unjustly denied or mishandled, contact a subject matter expert
to take care of those tangled threads before the knot worsens. Negotiation is part of the
process, thus, never hesitate to contact a professional for consultations and legal help.
● Reinstating lapsed insurance policy
