Grievance letter to the insurance company — format and sample

The grievance letter goes to the insurer's Grievance Redressal Officer (GRO). It names the claim, quotes the rejection ground, answers it point by point and attaches the documents. The insurer must acknowledge it at once and resolve it within 14 days. Keep the acknowledgement — the Insurance Ombudsman will ask for it.

Step by step

  1. Address it to the Grievance Redressal Officer

    Every insurer publishes the GRO's email and postal address on its website. Use email or the grievance portal so the date is on record.

  2. Subject line

    "Grievance against rejection of claim no. [claim number], policy no. [policy number], patient [name]".

  3. Facts in four lines

    Policy and start date, admission and discharge dates, hospital, claim amount, date of the rejection letter.

  4. Answer each ground

    Quote the ground in the insurer's words, then your answer and the document that proves it.

  5. Say what you want

    Reconsideration and payment of the claim amount of ₹[amount], with interest, within 14 days.

  6. Attach and send

    Rejection letter, policy schedule and wording, proposal form, treating-doctor certificate, discharge summary, bills.

Sample grievance letter

To: The Grievance Redressal Officer, [Insurer name]. Subject: Grievance against rejection of claim no. [ ], policy no. [ ], patient [ ].

Sir / Madam, I hold the above policy since [date]. [Patient] was admitted to [hospital] from [date] to [date] for [illness/procedure], and a claim of ₹[amount] was made. By letter dated [date] the claim was rejected on the ground that "[quote the ground]".

The rejection is not sustainable because: (1) [answer to ground 1 — e.g. the condition was first diagnosed on [date], after the policy began; certificate of the treating doctor enclosed]; (2) [answer to ground 2].

I request you to reconsider the claim and pay ₹[amount] within 14 days. If it is not resolved, I will approach IRDAI and the Insurance Ombudsman. Enclosed: [list]. Yours faithfully, [name, mobile, email].

After you send it

No reply in 14 days, or a reply that repeats the rejection: register on Bima Bharosa and prepare the Insurance Ombudsman complaint. The grievance letter and its acknowledgement are the first documents the Ombudsman asks for.

Related guides

How long does the insurer have to reply to a grievance?

It must acknowledge the grievance immediately and resolve it within 14 days.

Do I need a lawyer to write a grievance letter?

No. It is a plain letter. What matters is that it answers each rejection ground with a document.