Legal notice to an insurance company

A legal notice is a formal written demand to the insurer to pay a wrongly rejected or delayed claim within a fixed time, failing which you will go to the Ombudsman or consumer commission. It is not compulsory before a consumer complaint, but a precise notice often produces a settlement — and becomes evidence of the insurer's conduct if it does not.

Step by step

1. Identify the addressees

   The insurer's registered or branch office and its Grievance Redressal Officer, and the TPA if one handled the claim.

2. Set out the facts

   Policy number and period, insured person, hospitalisation dates, claim number, amount, and the date and ground of rejection.

3. Answer the ground

   Quote the policy clause and the IRDAI rule — for example the 60-month moratorium or the 36-month cap on the pre-existing disease waiting period — and the evidence that defeats the ground.

4. Make the demand

   Payment of the claim with interest, by a fixed date — commonly 15 days — failing which you will approach the Insurance Ombudsman or the consumer commission and seek compensation and costs.

5. Send it so it counts

   By registered post or speed post with acknowledgement, and by email. Keep the receipts and the tracking record.

If the insurer ignores the notice

File with the Insurance Ombudsman (within one year of the final rejection, compensation up to ₹50 lakh, free) or the consumer commission (within two years). Attach the notice and proof of delivery.

Have it drafted for you

Medilock drafts and sends the notice and follows it through to the Ombudsman or consumer commission. Legal fees are 15% + GST of what is actually settled — nothing if the claim is finally rejected.

Related guides

• Consumer court for a rejected claim
• Insurance Ombudsman complaint
• Legal help for a rejected claim
• All rejected-claim guides

Is a legal notice mandatory before consumer court?

No. It is not mandatory for a consumer complaint, but it often leads to settlement and is useful evidence.

How many days should a legal notice give the insurer?

Commonly 15 days to pay or respond. There is no single fixed period for a claim demand.

Can I send a legal notice myself?

Yes. A notice does not have to come from a lawyer, but it should be precise about the facts, the ground and the relief.