Health insurance claim delayed or pending for months?

An insurer has to settle or reject a claim within 30 days of receiving the last necessary document — 45 days where it investigates — and pays interest at 2% above the bank rate if it is late. A claim kept open with repeated queries for documents you have already sent is a grievance in its own right. Ask in writing for the specific document still needed, then escalate to the grievance officer, Bima Bharosa and the Insurance Ombudsman.

Step by step

1. Write down the last date you sent documents

   The settlement clock runs from the last necessary document the insurer received. Keep the courier receipt or email.

2. Ask for a decision in writing

   Email the insurer or TPA quoting the claim number: list what you have sent, ask which specific document is still required, and ask for a decision within the 30-day period.

3. Refuse duplicate queries

   Answer a genuinely new query once. A request for something already submitted is a delay tactic — say so and attach the earlier submission.

4. Escalate after 14 days

   Complain to the Grievance Redressal Officer; after 14 days without resolution, register on Bima Bharosa.

5. Go to the Ombudsman

   One month after your written complaint to the insurer without a satisfactory reply, the Insurance Ombudsman can hear it — and can direct interest for the delay.

Interest on a delayed claim

Where the insurer settles late, it owes interest at 2% above the bank rate from the date the claim should have been paid. Ask for it in your representation; insurers rarely add it unprompted.

Signs a delay is turning into a rejection

• A query for "complete indoor case papers" weeks after discharge
• An investigator calling about past treatment or old prescriptions
• Questions about when symptoms first started
• The claim marked "closed — documents awaited"

Related guides

• Claim rejected? What to do
• IRDAI complaint (Bima Bharosa)
• Insurance Ombudsman complaint
• Legal help for a rejected claim
• All rejected-claim guides

How long can an insurer take to settle a health insurance claim?

30 days from the last necessary document, or 45 days where the claim is investigated. After that it owes interest at 2% above the bank rate.

My claim was closed for "documents not received". What now?

Send the documents again with proof of the first submission and ask for the claim to be reopened in writing. If it is not, complain to the grievance officer and then the Ombudsman.

Can I complain about delay alone?

Yes. Delay is a grievance in its own right with the insurer, IRDAI and the Ombudsman.