ਆਪਣੀ ਜਾਣਕਾਰੀ ਭਰੋ

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: ____________________