A policyholder, nominee or claimant calling on an insurer to pay, settle or put right a claim or policy decision.
Date: 1 April 2026
TO:
The Grievance Officer, Example General Insurance Company Ltd.
Regional Office, Sector 17, Chandigarh 160017
And also at: X
FROM:
Ramesh Kumar
House No. 214, Sector 15-A, Chandigarh 160015
Phone: 98765 43210
Email: ramesh.kumar@example.com
SUBJECT: Notice about policy no. P/190000/01/2025/004512
Dear Sir / Madam,
1.1 The Recipient issued a family floater health insurance policy, policy number P/190000/01/2025/004512 (the Policy), to Ramesh Kumar. The Sender is the policyholder.
2.1 The Sender was hospitalised from 4 to 9 May 2026 for an emergency appendix surgery. A cashless request was made on 4 May 2026 and a reimbursement claim with all bills and the discharge summary was lodged on 18 May 2026.
2.2 The claim was registered with the Recipient under reference CLM/2026/118342.
2.3 The Recipient has rejected the claim.
2.4 The reason the Recipient gave, and the date of its letter or message, is: By its letter of 30 June 2026 the Recipient rejected the claim saying that the condition was a pre-existing illness not declared at the time of the proposal.
2.5 The Sender has already raised the matter with the Recipient: A complaint to the Recipient's grievance officer on 8 July 2026 (ref. GR/4471); no reply was received.
2.6 The Sender has complied with the terms of the Policy and has given the Recipient the documents and information it asked for. The Sender disputes the Recipient's position and says that it is not supported by the terms of the Policy or by the law.
3.1 The Sender calls upon the Recipient, within 15 days of receipt of this notice, to do the following: withdraw the rejection of the claim and pay the claim in full, with interest from the date of the claim
3.2 The amount the Sender claims under the Policy is ₹2,85,000 (Rupees Two Lakh Eighty Five Thousand only), together with interest and costs as the law allows.
3.3 The Recipient is also asked to send the Sender, within the same time, a written reply that gives the reasons for its decision and a copy of the Policy document, the proposal form and any survey or investigation report it relies on.
4.1 If the Recipient does not comply, the Sender will pursue such remedies as the Sender is advised, which may include a complaint to the Insurance Ombudsman, a complaint to the Insurance Regulatory and Development Authority of India, a complaint before the Consumer Disputes Redressal Commission, or a civil suit, with interest, compensation and costs.
4.2 Nothing in this notice waives any right or remedy of the Sender.