Kaagazaat

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Appeal Against Claim Rejection

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How will the letter be sent?Needed

A calendar date — the day, the month and the year. Dates in a document like this are read against one another, so a date typed here can change what another date is allowed to be.

For example: 20 November 2026

For example: Ludhiana

For example: HDFC ERGO General Insurance Company Limited

What is the address of the grievance redressal officer?Needed

For example: Manpreet Singh Sidhu

What is your postal address?Needed

An email address somebody actually reads. Notices under a document like this can be sent to it, so a working one matters more than a tidy one.

For example: manpreet.sidhu@example.com

A number somebody can be reached on. Ten digits is the usual Indian form, and a country code in front of it is fine if you want it there.

For example: +91 98723 40018

For example: policyholder

For example: 2315/0098/2026/00821

For example: a family floater health policy valid from 1 April 2026 to 31 March 2027

For example: CLM/2026/448821

A calendar date — the day, the month and the year. Dates in a document like this are read against one another, so a date typed here can change what another date is allowed to be.

For example: 9 September 2026

For example: the hospital treatment of my wife for a gall bladder operation

An amount in rupees. Commas and a ₹ sign are both fine — write it the way you would write it anywhere else, and the document is given the tidy form of it.

For example: 142000

A calendar date — the day, the month and the year. Dates in a document like this are read against one another, so a date typed here can change what another date is allowed to be.

For example: 14 October 2026

For example: ref no. HE/REJ/2026/7731

What did the insurer decide?Needed

Copy the reason from the letter, in its own words as far as you can.

A long answer. Several lines are fine, and a break you make between paragraphs is the break the document keeps.

For example: The treatment is said to be for a pre-existing condition that was not disclosed at the time of proposal.

Say in plain words why the reason does not fit the facts or the policy.

A long answer. Several lines are fine, and a break you make between paragraphs is the break the document keeps.

For example: My wife had no gall bladder complaint before the policy began. The first scan was on 1 September 2026 and no doctor treated her earlier.

The dates, the doctor's statements and the papers that back what you say.

A long answer. Several lines are fine, and a break you make between paragraphs is the break the document keeps.

For example: The scan report of 1 September 2026 and the doctor's note of 3 September 2026 say that the stones were found for the first time then.

Have you read the clause the insurer relies on?Needed

For example: in full, being the amount claimed

Letters, calls or emails to the insurer, with dates.

A long answer. Several lines are fine, and a break you make between paragraphs is the break the document keeps.

For example: I wrote to the claims office on 16 October 2026 and spoke to its manager on 20 October 2026; I received no change.

For example: BB-2026-221140

Anything the other questions did not cover. Leave blank if none.

A long answer. Several lines are fine, and a break you make between paragraphs is the break the document keeps.

For example: Please send the reply to my email as well as by post.

Number each paper: the rejection letter, the policy and its wording, your claim, the bills and reports, and the letters exchanged.

A long answer. Several lines are fine, and a break you make between paragraphs is the break the document keeps.

For example: 1. Rejection letter. 2. Policy schedule and wording. 3. Claim form and claim letter. 4. Hospital bills and reports. 5. Letters and emails with the insurer.

For example: Kuldip Singh Sandhu

An email address somebody actually reads. Notices under a document like this can be sent to it, so a working one matters more than a tidy one.

For example: kuldip.sandhu@example.com

Which consent statement should print?Needed

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No answer has been given, so every place a detail belongs is standing blank. The shape of the document is worth reading even now.

APPEAL AGAINST CLAIM REJECTION

Appeal to the Grievance Redressal Officer against the rejection or part-payment of an insurance claim

Date: __________, at __________

__________

To: The Grievance Redressal Officer, __________, __________

From: __________, __________ (email __________, telephone __________)

Subject: Appeal against the decision on claim no. __________ under policy no. __________

Sir or Madam,

  1. 1. Who I am. I am the __________ under policy no. __________ issued by you, which is __________.
  1. 2. The claim. I made a claim, no. __________, on __________ for __________.
  1. 3. Your decision. By your letter dated __________, __________, you __________. The reason you gave was: __________
  1. 4. Why I disagree. __________
  1. 5. The facts as I say them to be. __________
  1. 6. The policy. __________
  1. 7. What I ask you to do. Please do all of the following.

(a) Look at the decision afresh, with the papers I have enclosed, and not merely repeat the reason already given.

(b) Withdraw the rejection or the deduction and pay the claim, __________

(c) If you do not agree, tell me in writing, with the clause of the policy and the fact you rely on for each ground, and send me the surveyor's, doctor's or investigator's report that was used.

(d) Give your decision within the time the rules on policyholders' interests allow, and tell me the date by which you will do so.

  1. 8. Earlier steps. __________
  1. 9. What I promise. What I have written is true to the best of my knowledge, and I have not kept back any fact that you would reasonably want to know.
  1. 10. If this appeal fails. If you uphold the rejection, give only part relief or do not reply, I will complain to the Insurance Ombudsman for the area, and I am free to bring a consumer complaint before the District Consumer Disputes Redressal Commission. I ask that you treat this letter as the written representation to the insurer that the Ombudsman's rules look for.

Please acknowledge this appeal in writing and give me the name of the officer handling it.

ENCLOSURES

__________

LEGAL BASIS

Punjab: An insurance policy is a contract, and an insurer that rejects or cuts a claim must have a ground in the policy; the policyholder may ask the insurer's grievance redressal officer to reconsider it, and the insurer must deal with a complaint within the periods the insurance regulator's rules on policyholders' interests set, which the letter names without quoting a figure. A policyholder who is not satisfied can complain to the Insurance Ombudsman under the Insurance Ombudsman Rules, 2017, after the insurer has rejected the complaint or has not answered within the time those Rules allow, or file a consumer complaint before the District Commission under section 35 of the Consumer Protection Act, 2019, a remedy in addition to other laws under section 100. A dispute that needs a civil court goes to the civil court, with an appeal to the District Judge or the Punjab and Haryana High Court.

Chandigarh: The same law applies to a policyholder in the Union Territory: the insurer's grievance redressal officer is the first step, then the Insurance Ombudsman under the Insurance Ombudsman Rules, 2017, or a consumer complaint before the District Commission serving the Union Territory under section 35 of the Consumer Protection Act, 2019. A dispute for a civil court goes to the civil court at Chandigarh, with an appeal to the District Judge, Chandigarh, or the Punjab and Haryana High Court.

PERSONAL DATA NOTICE

This notice is given under the Digital Personal Data Protection Act, 2023.

The purpose of collecting the personal data in this appeal is to identify the policyholder and the claim, set out why the decision is disputed, and let the insurer's grievance officer reconsider it.

The record will be held by __________ and may be shared with The insurer and its claims, surveyor and grievance officers, the Insurance Ombudsman, any Consumer Commission or court that hears the matter, and the claimant's advocate.

If the matter does not proceed, the personal data will be retained for 90 days and then erased. If the matter proceeds, the record will be retained for the transaction or authority matter plus 12 months, except where a statute requires a longer named retention period.

A person named in this document may request correction or erasure where the purpose has ended, withdraw consent for future consent-based processing, or raise a grievance by writing to __________. The record-holder should acknowledge and reply within 30 days.

Data minimisation: this document does not collect a full Aadhaar number, an Aadhaar-card copy, a password or bank credentials.

Personal-data instruction: __________.

SIGNATURE

 
 
______________________________
Signature
Appellant: __________
Place: ____________________
Date: ____________________

The rest stays out of view until every answer is in.

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