Buying a policy is the easy part. Getting a claim approved, fully and on time, is where most families struggle. This is your complete guide to how claims actually work in India, why they get delayed or rejected, and how Policy Aid stands between you and the insurer until your claim is settled — at no extra cost.
Every year, lakhs of health, motor and travel insurance claims in India are delayed, partially settled, or rejected outright — and a large share of these don't have to be. According to IRDAI's annual reports, health insurers settle the vast majority of claims, but rejection and "not admitted" rates still run into double digits at several insurers, and a meaningful share of reimbursement claims face queries, deductions or repudiation on technical grounds rather than genuine ineligibility.
Most policyholders only read their policy document twice in their life: once when they buy it (briefly), and once when they're trying to file a claim under stress — in a hospital corridor, after a car accident, or stranded at an airport overseas. That's the worst possible time to discover a waiting period clause, a sub-limit, or a documentation requirement you didn't know existed.
This page exists to change that. Below, we break down — in plain language — how claims work for health, motor and travel insurance in India, the most common reasons claims get rejected or reduced, the exact documents you'll need, and what to do if you feel your claim has been treated unfairly. And if you'd rather not navigate this alone, our team handles the back-and-forth with the insurer for you, free of charge, as part of the service we provide as your IRDAI-licensed insurance agent.
Most rejections aren't because the claim wasn't genuine — they're because of something that happened (or didn't happen) long before the claim was filed. Click each reason to understand it, and how to protect yourself.
As your IRDAI-licensed insurance agent, our role doesn't end when you buy a policy. Here's what claims assistance from Policy Aid actually looks like, at each stage.
The best claims support happens before anything goes wrong:
Message us on WhatsApp the moment you're admitted, in an accident, or facing a travel mishap. We will:
Claims rarely move in a straight line. We:
This is where we add the most value:
Health claims fall into two types: cashless, where the hospital bills the insurer directly through a TPA, and reimbursement, where you pay first and claim later. Cashless is faster and easier but only works at network (empanelled) hospitals — and even then, pre-authorisation can be partially approved, queried, or denied if the estimate looks inflated or the diagnosis doesn't clearly support the treatment.
Reimbursement claims work anywhere but require meticulous documentation: every original bill, the discharge summary, investigation reports, and a correctly filled claim form, submitted within 15-30 days of discharge depending on your insurer.
For the full step-by-step process — including our interactive cashless and reimbursement journeys, complete document checklists and FAQs — see our dedicated guide.
Motor claims arise from accidents (own-damage and third-party), theft, and natural calamities. Like health insurance, you can choose cashless repair at a network garage (the insurer settles directly with the garage, minus your deductible) or pay and file a reimbursement claim for repairs at any garage.
Speed matters here too: inform your insurer immediately after an accident or theft, take photos of the damage and the scene before the vehicle is moved (where safe to do so), and for theft or major third-party damage involving injury, file a police FIR — this is mandatory for theft claims and strongly advisable for any accident involving another vehicle, pedestrian, or property.
A surveyor appointed by the insurer will assess the damage before repairs begin (for claims above a threshold) — repairing the vehicle before the survey can jeopardise your claim.
Travel insurance claims cover a wider variety of situations than health or motor: medical emergencies abroad (often involving direct cashless settlement via the insurer's international assistance partner), trip cancellation or curtailment, flight delays, lost or delayed baggage, and passport loss.
The single most important habit for travel claims is collecting proof at the point of failure. A delayed flight needs a written delay certificate from the airline. Lost baggage needs a Property Irregularity Report (PIR) filed with the airline before you leave the airport. A medical emergency needs hospital records and bills, even if treatment was cashless. Without this contemporaneous proof, even a completely genuine claim becomes very difficult to support after you've returned home.
Most travel insurers provide a 24x7 international helpline number — saving this number (and your policy number) somewhere accessible before you fly is one of the simplest things you can do to protect yourself.
A quick comparison of timelines, key documents, and where to escalate for each type of claim.
| Aspect | Health Insurance | Motor Insurance | Travel Insurance |
|---|---|---|---|
| Claim types | Cashless, Reimbursement | Cashless (network garage), Reimbursement, Third-party | Medical (cashless via assistance), Reimbursement (baggage, delay, cancellation) |
| Intimation window | 24 hrs (emergency) / 48-72 hrs (planned) | As soon as possible, within 24-48 hrs | Immediately — call the 24x7 international helpline |
| Key proof to collect | Discharge summary, all bills, investigation reports | Photos of damage/scene, FIR (for theft/major accidents), surveyor report | PIR (baggage), delay certificate (flights), hospital records (medical) |
| Filing deadline | 15-30 days from discharge | Within policy terms; immediate intimation strongly advised | Typically within 30 days of return or as specified in policy |
| Typical settlement time | 7-15 working days (post documents) | 5-10 working days for cashless repairs | Varies — medical assistance can be near-real-time; reimbursements 2-4 weeks |
| Common reduction reason | Room rent capping, sub-limits, co-pay | Depreciation (unless Zero-Dep), policy excess | Sub-limits per claim category, exclusions for pre-existing conditions |
| If rejected, escalate to | Insurer GRO → IRDAI Bima Bharosa → Insurance Ombudsman | Insurer GRO → IRDAI Bima Bharosa → Insurance Ombudsman / MACT (for third-party injury) | Insurer GRO → IRDAI Bima Bharosa → Insurance Ombudsman |
These documents come up across almost every claim type. Keep digital photos or scans of each from day one — don't wait for a claim to start collecting them.
Proof of coverage & policy number
Aadhaar, PAN or passport
From insurer or TPA portal
Every bill, however small
For NEFT settlement
Diagnosis & treatment record
Before vehicle is moved or repaired
Mandatory for theft, advisable for accidents
From the airline, before leaving the airport
For cashless approvals
Insurer-appointed assessment
Emails, SMS, query letters — keep it all
A rejection letter is not the end of the road. IRDAI has a structured, free, time-bound grievance process — here's how it works, step by step.
If you haven't already received one, ask the insurer for a written rejection or deduction letter that clearly states the reason (the policy clause, condition or exclusion being applied). You're entitled to this — verbal explanations aren't enough to act on.
A large share of "rejections" are actually queries for missing or unclear documents. Re-read the letter carefully — if it asks for something specific (a clarification letter from the doctor, a missing bill, a corrected form), provide it promptly. This alone resolves a significant portion of cases without any formal escalation.
Every insurer publishes the contact details of its GRO on its website (and on policy documents). Send a written complaint — email is fine — explaining why you believe the decision is incorrect, with copies of supporting documents. The insurer must respond within 14 days under IRDAI's Grievance Redressal guidelines, and the overall complaint should be resolved within 30 days.
If the GRO doesn't respond within 30 days, or you're not satisfied with the resolution, file a complaint on IRDAI's Bima Bharosa portal (bimabharosa.irdai.gov.in) or call the IRDAI Grievance Call Centre (toll-free: 155255 / 1800-4254-732). IRDAI forwards your complaint to the insurer with a tracked timeline and monitors the response.
For unresolved complaints (or claims rejected/reduced) up to ₹50 lakh, you can approach the Insurance Ombudsman in your region — a free, quasi-judicial forum set up specifically for policyholder disputes. You can file a complaint online via the Council for Insurance Ombudsmen (cioins.co.in) within one year of the insurer's final rejection. The Ombudsman can pass an award binding on the insurer, typically within 3 months.
For claims above the Ombudsman's limit, or if you'd prefer a formal legal route, you can file a complaint under the Consumer Protection Act at the District, State, or National Consumer Disputes Redressal Commission, depending on the claim value. This route takes longer but carries full legal weight.
Don't want to navigate this alone? Our team can help you draft the representation letter, organise your supporting documents, and follow up with the insurer at each stage — message us on WhatsApp with your policy and claim details.
Quick, straight answers to what people ask us most about claims.
For the most up-to-date rules and to escalate directly, these official sources are worth bookmarking.
India's insurance regulator — circulars, regulations and consumer notices
File a complaint against an insurer directly with IRDAI
Free, independent grievance redressal for claims up to ₹50 lakh
Policyholder handbooks and rights guides published by the regulator
Whether you're about to file a claim, stuck mid-process, or have already received a rejection — message us with your details and our team will tell you exactly what to do next, free of charge.