NCDRC Lawyer for Insurance Claim Rejection and Compensation
An Insurance Policy is taken to guard against uncertain events. If the claim is rejected without any valid reason. Then you could end up paying for Hospital expenses, Business losses or pay for life after death or accident.
What I can help you with when you hire an NCDRC Lawyer for Insurance Claim Rejection and Compensation? Can the Insurance company decision be questioned, What is the remedy available to you and what all documents are required. These answers will vary based on your policy document, reasons for rejection and value and nature of your case and what law applies to your matter.
If you reside in Delhi NCR and India you can contact BK Singh Advocate who works with us NCDRC Lawyers to know about your options. Just because you have received a rejection letter doesn't mean that your Insurance Company has committed an offence. Nor should you take your Insurance company for granted.
By reading through your Policy words, Proposal, Claim and correspondence you can identify where the problem lies. Sometimes sending a grievance letter to your insurer will help. But at other times you may need to file a Consumer Complaint or approach Insurance Ombudsman or Appeal.
NCDRC is the National Consumer Disputes Redressal Commission which is an apex body to resolve consumer disputes in India. You cannot directly approach them for every rejected claim. Knowing which Forum to approach and within what time frame is very important while analysing your case.
Why Does Insurance Claim Rejection Matter in Delhi NCR and Across India?
Insurance claims are built over years of premium paid and it could be the lifeline for your family. So when the insurance company denies your claim the implications could be much higher than what is written on that claim form.
The family in Noida could be left with arranging money when their health insurance claim is denied. The shop keeper in Ghaziabad could be out of pocket for repairing his store after his fire insurance claim is rejected. The business in Gurugram could be unable to recover on its insurance claim for property damaged. There could be disputes around life insurance as well affecting the nominees of a policy holder.
People from Delhi, New Delhi, Faridabad, Meerut, Mumbai, Pune, Bangalore, Hyderabad, Chennai, Kolkata, Jaipur, Lucknow and rest of India face these issues. Their situations vary but they all revolve around one question. Was your insurance claim denied wrongly by applying the terms of policy and the law?
You can speak to us at BK Singh Advocate & NCDRC Lawyers to review your documentation and what options you may have. Depending on the policy, person and type of loss will determine what forum you can approach.
What Is the Main Concern After a Claim Is Rejected?
The initial question to be asked is why has the insurance company declined to pay. The refusal could be due to many reasons such as an exclusion being applied, non disclosure is alleged, they believe the loss did not occur as stated, no proof or breach of a policy condition is believed to have occurred.
It's important to remember that not all declined claims are wrongfully declined. There may be circumstances that your policy does not cover for or you may need to look at whether the insurer's reasoning is correct based on the wording of your policy and evidence available.
By obtaining a legal opinion you will know if your claim has been lawfully declined under your policy. Which can then help you decide if you would like to proceed with writing to the insurer, lodging an IGD or make a claim in a consumer tribunal.
Quick Facts
Keep in mind that your Grievance or communication with the Insurer does not stop the clock of limitation.
What Documents and Evidence Should You Prepare?
Having good documents will help your cause. Collect all documents related to your insurance issue before visiting BK Singh Advocate or any other expert advocate.
Documents you should have:
- Your Policy copy, schedule, riders, renewals.
- Proposal form and declaration (if you have them) while buying the policy.
- Premium paid receipt copies and policy servicing.
- Claim Form and Claim Number. Copy of receipt of your claim.
- Letter of repudiation / denial from the insurance company stating the reason.
- Medical records, bills, reports and discharge summary (in case of health insurance).
- Estimates, survey report, pictures, bills and proofs of loss (in case of Motor Insurance / Property Damage)
- Correspondence with the Insurance Company (emails/letters/complaints and reply)
- Documents proving your loss and compensation claimed.
- Any previous complaint filed/order/appeal papers and limitation documents (if applicable).
Why Does the Rejection Letter Matter?
As mentioned above this will show what the insurers stand on. Whether it be that they state you have failed to disclose information then you may want to look at your proposal form and any medical or other records that could relate. If they are using an exclusion look at the policy wordings and what facts support that.
Have all documentation readily available and provide true copies of any documents. Do not falsify any records or withhold facts from your claim. If you believe your loss to be a certain amount ensure that you can back that up. NCDRC Lawyers can assist with collating all relevant paperwork and let you know if there are any holes in your file that we would need clarified before proceeding.
What Can a Policyholder Do After an Insurance Claim Is Rejected?
It will depend on the nature of insurance, why it was repudiated and if there is any proceeding that has already commenced. There is no one path that applies in every case.
Go through the reason of insurer.
Look at the policy wordings and see what reason has been given for rejection by insurer. Is there any exclusion or allegation of breach. Any record not found or any disputed fact mentioned by insurer.
File a Grievance
Policyholder can file a written grievance against insurer and ask them to respond with reason. Maintain copies of submission and responses received. The grievance redressal mechanism can sometimes help resolve the issue. However, this will not necessarily stay all limitation periods applicable.
Resort to other external forums.
This could be the grievance mechanism of insurer or approach the Insurance Ombudsman if it is within the scope of Ombudsman or take the matter to a Consumer Commission. There will always be some requirement which you need to satisfy when filing a complaint or appeal.
BK Singh Advocate can guide you if your case is eligible to approach a Consumer Forum and which forum would be ideal in your case i.e. District Commission, State Commission or National Consumer Disputes Redressal Commission. Just because you want higher quantum doesn't mean that your matter will lie before National Commission.
When Should You Consult an NCDRC Lawyer?
You may wish to obtain legal advice if an Insurer has declined your claim finally. Or the sum in question is large. Or the decline seems unjustifiable in light of the policy and/or available evidence.
Advice from an attorney may also be beneficial if:
- Your Insurer is applying an exclusion which you think is not applicable.
- You have a medical, life, motor, property or business insurance claim which has been declined in whole or part.
- Your Insurer does not agree with what caused your loss.
- Your consumer complaint was dismissed or you were granted an adverse order.
- You need advice on how to appeal or issues regarding limitation, jurisdiction or what evidence you need.
- You have been served with something or need to answer a matter that is before a court.
Obtaining advice at an early stage may allow you to obtain certain records or become aware of time lines. It will not ensure payment, quantum or that you succeed in your claim.
How Can NCDRC Lawyers Help With Insurance Claim Rejection?
NCDRC Lawyers provide you with a help desk to know more about your case when it comes to Insurance policies. BK Singh Advocate will guide you to know what your policy says, what reason was given to reject your claim and what are your options as per law on the documents you have.
This can involve helping you understand your claim file and what Consumer Law says. It can also be to help you draft a complaint or look into it. If there is a provision for appeal then that can be done as well. Taking up your case in the concerned forum.
The client should be informed about what they are dealing with. What their options are, what steps would have to be taken and what the documents can and cannot do. Forum and relief will depend on what law says and not on brochures.
Know more about NCDRC Lawyers here.
Frequently Asked Questions
1. Can you appeal against insurance claim rejection in India?
Yes you can appeal if you are an eligible policy holder through proper forum/grievance redressal forum. It depends upon your policy, facts & circumstances and limitation period.
2. How can an NCDRC Lawyer help in Insurance Claim Rejection?
He can go through the rejection letter and can advise you further. He can also guide you what are your options as a consumer in case of insurance claim rejection.
3. Can I file a case directly in NCDRC?
No. It depends upon original jurisdiction. You might have to approach the District or State Commission.
4. What amount of compensation can I claim for insurance claim rejection?
There is no fixed amount of compensation. It depends upon what you are claiming whether its amount covered under the policy or any interest/compensation etc. It has to be based on facts and circumstances.
5. Can I appeal against Health Insurance Claim Rejection?
Yes. You should check your policy document, treatment taken by you, any exclusion clauses, what all you have disclosed to the insurance company and what is the reason of rejection. After this you can decide which remedy you should take.
6. My Life Insurance claim was rejected on the ground of non disclosure. What to do?
You should see what all questions were asked on the proposal form and what all information you have given. You should also look into your policy document and section of law which may apply on your case.
7. Can I claim compensation for delayed settlement of insurance claim?
If the facts and circumstances of your case allows it then yes you can.
8. What are the documents required to file an insurance claim complaint?
Your policy copy, premium paid receipts, claim form filled by you, rejection letter and bills/reports if any. Also any communication between you and insurance company and documents on which you have suffered any loss.
9. Do I need the rejection letter to file an insurance complaint?
Its very helpful because you will know what reasons have been given by the insurance company for rejecting your claim. But if they haven't sent you any such letter you can save all the communication and write to them.
10. What is the limitation period to file a consumer complaint?
As per section 69 of Consumer Protection Act, 2019 you have to file your case within 2 years from when cause of action has arisen. It may be condoned if there are some circumstances which allows it.
Conclusion
Just because an insurance company has rejected your claim doesn't mean they were right to reject it. One has to look into the policy, documents and law to figure out if the policy holder has any right to claim against the insurance company and why they denied him from receiving money.
By doing an initial assessment one can figure out what remedies you have available to you. Also it can save you time by making sure you don't commit errors that could be detrimental to your case. Find out if you can file a complaint against them or appeal the decision. Keep in mind about limitations period as well and keep copies of all your correspondences.
If you are located in Delhi NCR or anywhere else in India feel free to reach out to BK Singh Advocate and NCDRC Lawyers to speak about your Insurance Claim Rejected. There may be ways you can get compensated for your losses. Always base your actions off of what you know about the case at hand.
There's no reason for concern. There is no difficult-to-understand legalese.
Someone who has helped many people with the same problems gives you clear, honest advice. We want to make the legal process easy to understand and use for everyone.
Schedule Your Consultation