How to file an Insurance Ombudsman complaint for a health claim

Last checked against the source documents on 4 November 2026. General information, not legal advice.

The Insurance Ombudsman is a free forum under the Insurance Ombudsman Rules, 2017. It can hear complaints about rejected, part-paid and delayed claims. Here is how it works, taken from the Rules and the Council for Insurance Ombudsmen's portal.

Can you file yet?

Your situation	Can you file?	Last date
You have not complained to the insurer in writing	No. Do that first.	Treat one year from the rejection as your safe date
You complained, and they replied but you disagree	Yes, now	One year from their reply
You complained, and they did not reply	Yes, one month after you sent it	One year after that month ends

If you are late, you can still file and ask for the delay to be condoned. The Ombudsman has that power under Rule 14(4), though it is not automatic.

Who can file

Rule 14(1) says the person with the grievance can file, personally or through their legal heirs, nominee or assignee. Group policies are covered. The Ombudsman can award up to ₹50 lakh, including relevant expenses (Rule 17(3)).

What your complaint must contain

Rule 14(2) asks for your name and address, the insurer's branch or office, the facts supported by documents, the nature and extent of your loss, and the relief you want.

What the online form asks

1. Mobile number and OTP. It lasts 90 seconds, so keep your phone ready.
2. Your details and relation to the insured.
3. Your state, city, address and PIN.
4. Policy number, date of occurrence, insurer, insured's name and compensation sought.
5. The Ombudsman centre, whether you complained to the insurer and when, whether they replied, and brief details of the complaint.
6. Uploads in PDF or JPG, up to 10 MB each. A copy of your complaint to the insurer and your ID and address proof are required. The rejection letter, photograph, policy copy and other documents go in the other upload fields.

Choose the centre that covers your home or the insurer's branch. If you see a high traffic alert, it is asking whether you agree to a different centre and an online hearing.

What happens next

• Often, the insurer looks again. Once notified, some insurers settle. One policyholder's published account describes the insurer agreeing to pay within weeks of filing.
• Mediation, if both sides consent in writing. The Ombudsman makes a recommendation within a month. You get 15 days to accept, and accepting means full and final (Rule 16).
• Otherwise, an award. It is due within three months of the Ombudsman receiving all requirements from you (Rule 17(4)).
• Compliance. The insurer must comply within 30 days (Rule 17(6)). If it does not honour the award, a penalty of ₹5,000 per day is payable to you (Master Circular, Chapter I, para 20).