Your claim was rejected. That is not the end of it.
Indian insurers repudiated Rs 10,937 crore of health claims and disallowed another Rs 15,100 crore in FY2023-24 alone. A rejection letter is an insurer opinion, not a verdict. RiskPe reviews rejected insurance claims, tells you honestly whether yours is recoverable, and pursues it if it is.
How often insurance claims are rejected in India
All figures below are from the IRDAI Annual Report 2023-24 and the Council for Insurance Ombudsmen.
Health insurance claim rejections rose 19.10 per cent year on year, from Rs 21,861 crore in FY2022-23. Complaints against health insurers rose 21.7 per cent to 31,490 in the same period.
How RiskPe claim recovery works
We are a fee-based, zero-commission advisory. We are not paid by insurers, so there is no incentive to tell you a weak claim is strong.
1. Paid review of the rejection
You pay a review fee and send us the rejection letter, the policy wording and the claim file. We work out whether the ground the insurer relied on actually holds up against your policy.
2. An honest verdict
If the claim is genuinely not payable, we tell you so and return your review fee. We would rather refund you than take a case we cannot win.
3. We build and file the case
If it is recoverable, we prepare the representation, escalate to the insurer grievance officer, and take it through IRDAI and the Insurance Ombudsman as required.
4. We are paid from what we recover
On a successful recovery, RiskPe receives an agreed share of the amount recovered. If we take the case on and recover nothing, the review fee is not returned — that is the risk we ask you to share.
In plain terms. Not payable, and you get your review fee back. Payable and recovered, and we take an agreed share of the recovery. Payable, we fight it, and it still fails — you lose the review fee and we are paid nothing. All amounts are confirmed in writing before any work starts.
Claims we take on
Usually recoverable
- Rejection cites a clause that does not cover the facts
- Alleged non-disclosure of something unrelated to the treatment
- Proportionate deduction or room-rent capping applied incorrectly
- A purchased add-on, such as zero depreciation, was not applied
- Refusal on documents you can still produce
- Life claims beyond three years, where Section 45 protection applies
Usually not worth pursuing
- An explicit exclusion that squarely applies to the treatment
- The policy had genuinely lapsed on the date of loss
- Waiting period for that specific ailment had not completed
- Deliberate misrepresentation the insurer can evidence
If your claim falls here, we say so at review stage and return your fee. That is the whole point of reviewing first.
Guides by claim type
Detailed, India-specific walkthroughs for the situation you are actually in.
Claim recovery FAQs
Can a rejected insurance claim be recovered in India?
Often, yes. A repudiation is the insurer position, not a final determination. You can escalate to the insurer grievance redressal officer, then to IRDAI through the Bima Bharosa portal, then to the Insurance Ombudsman, whose award is binding on the insurer. Whether a specific claim is recoverable depends on the ground cited and whether the policy wording actually supports it.
How much do insurers reject in India each year?
In FY2023-24 health insurers paid 71.29 per cent of roughly Rs 1.17 lakh crore claimed. They repudiated Rs 10,937.18 crore and disallowed a further Rs 15,100 crore, with rejections up 19.10 per cent year on year. Source: IRDAI Annual Report 2023-24.
What does RiskPe charge for claim recovery?
You pay a review fee upfront. If the review concludes your claim is not payable, that fee is returned to you. If we take the case on and pursue it but do not recover anything, the review fee is not returned. If we recover the claim, RiskPe receives an agreed share of the amount recovered. Exact figures are confirmed in writing before any work begins.
Which types of insurance claims does RiskPe recover?
Health, motor, term life and death claims, fire and property, marine, engineering and other commercial lines. The process is the same across lines: assess the rejection ground against the policy wording, then escalate through the insurer, IRDAI and the Insurance Ombudsman as required.
Is the Insurance Ombudsman free to approach?
Yes. The Insurance Ombudsman costs nothing to approach and its award is binding on the insurer. In FY2023-24 the 17 Ombudsman centres received 52,575 complaints and disposed of 49,705. You must first raise the dispute with the insurer grievance redressal officer.
How long does insurance claim recovery take in India?
It varies by stage. Insurers are expected to respond to a grievance within a defined window, and Ombudsman matters commonly take a few months from filing to award. Complex or high-value disputes that proceed to a consumer forum take longer.
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