CLAIM DENIED FIGHT BACK with your_friendly_author

Your health insurance claim was rejected, cashless was denied at discharge, or the insurer paid far less than the bill. Now what?

Every year, Indian health insurers reject or cut thousands of crores of rupees in claims. They cite "pre-existing disease," "not medically necessary," room-rent "proportionate deductions" or "reasonable and customary" limits. Most families give up, or pay a claim-recovery firm a registration fee plus a share of whatever it gets back.

You don't have to do either. India has a free, clear route for challenging an insurer's decision. This book walks you through it, one step at a time.

Inside you'll find:

• What to do in the first 48 hours, including at the hospital discharge desk
• How to read a rejection letter and get the exact policy clause and deduction sheet
• Your rights in plain English: IRDAI's 2024 rules on cashless timelines, the pre-existing disease definition, the 5-year moratorium and interest for delay
• How to answer each rejection reason: pre-existing disease and non-disclosure, medical necessity, room-rent deductions (with a worked example), "reasonable and customary" cuts, waiting periods and late intimation
• The escalation ladder: insurer grievance cell, IRDAI's Bima Bharosa, the Insurance Ombudsman (free, no lawyer, claims up to ₹50 lakh) and the Consumer Commission
• How to prepare for an Ombudsman hearing
• Special situations: a parent's claim, claims after a death, NRIs and employer group policies
• 14 ready-to-use letter templates, from the first grievance letter to the Ombudsman complaint
• Checklists, a deadline tracker and a worksheet for recalculating deductions

Written for policyholders, and for adult children handling a parent's claim. Rules are current as of September 2026.

This book gives general information, not legal advice.