Insurer paid less than you claimed? How to challenge the deductions

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

A short settlement is often harder to spot than a rejection, because money did arrive. You can dispute it through the same route. The Ombudsman Rules list "partial or total repudiation" as a ground for complaint (Rule 13(1)(b)).

Start by asking for line-by-line reasons

The Master Circular says that where a claim is "disallowed partially", details must be conveyed with full particulars and reference to the specific terms of your policy (Chapter I, para 17(b)). A settlement advice with one lump-sum deduction does not meet that standard, so ask for each amount and the clause behind it.

Common deductions, and what to ask

Deduction	What to ask
Room rent limit or proportionate cut	Which clause allows it? Show the calculation and which items were reduced. Was the limit in your Customer Information Sheet?
Reasonable and customary charges	What data was used? Which hospitals and what period? A bare statement that charges are high is not a reason.
Consumables and non-medical items	Is the item actually excluded under your policy wording or add-ons? Did you buy a consumables cover?
Sub-limits for a procedure	Where was the sub-limit disclosed? The Customer Information Sheet must list sub-limits and deductibles (para 4(b)).
Co-payment	Does your schedule state it? Was the correct percentage applied, and to the correct amount?

Be careful with discharge vouchers

If you are asked to sign a voucher that says "full and final", read it first. Write "under protest" if you intend to dispute the rest, and keep a copy. If you were pressed to sign, say so in your complaint.

Then follow the route

Complain in writing to the grievance officer, escalate to IRDAI's Bima Bharosa after 14 days if unresolved, then file with the Insurance Ombudsman. Is it worth it? Add up what you are disputing. Filing is free, so even a modest amount can be worth an hour of your time.