Insurance claim stuck, delayed or rejected?
Get help from claim specialists who know how insurers and TPAs work. We help you file correctly, chase pending claims, respond to queries, and escalate rejected claims through the right channels — for health, life, motor, fire and other policies.
Note: Only genuine claims will be responded
- Help even if you bought your policy elsewhere
- Support across all major insurers and TPAs in India
- One point of contact who follows up until your claim closes
Request Claim Assistance
Tell us about your claim and a claim support specialist will call you back.
Common insurance claim problems we solve
Claim delayed or stuck
Claim pending for weeks with no update? We track it with the insurer or TPA, find out what is holding it up, and push it to a decision.
Claim rejected
We review the rejection letter against your policy wording, identify whether the reason holds up, and help you contest it through the grievance process.
Partial or low settlement
Deductions for room rent limits, “non-payable” items or depreciation can add up. We check every deduction and help you dispute the ones that aren’t justified.
Cashless request denied
If the hospital’s cashless request was denied, we help you understand why, guide you on reimbursement, and make sure nothing is missed when you file.
Document queries from insurer
Repeated queries for documents can stall a claim. We tell you exactly what is needed and how to submit it so the claim keeps moving.
Help filing a new claim
Not sure where to start? We walk you through intimation, the claim form and the document checklist so your claim is right the first time.
How our claim assistance works
Share Your Details
Submit the form with your contact details and a short note about your claim.
Case Review
A claim specialist calls you, reviews your policy, claim status and insurer letters.
Follow-up & Paperwork
We help prepare documents and responses, and follow up with the insurer or TPA.
Escalation if Needed
If the insurer doesn’t resolve it, we guide you through grievance and Ombudsman escalation.
Why insurance claims get delayed or rejected
Most claim problems aren’t about the policy being “bad” — they come from gaps in paperwork, timing or communication. Knowing the common reasons helps you avoid them, and helps you push back when a rejection isn’t justified.
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Incomplete or mismatched documents
Missing bills, unsigned forms, or names and dates that don’t match across documents are the single biggest cause of delays.
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Late claim intimation
Most policies require you to inform the insurer within a set time after hospitalisation, an accident or a death. Late intimation can lead to questions, though genuine delays with valid reasons are often accepted.
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Non-disclosure of medical history
Insurers may question claims if a pre-existing condition or habit wasn’t declared in the proposal form. Whether the rejection stands depends on what was disclosed and how it relates to the claim.
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Waiting periods and exclusions
Initial waiting periods, specific-disease waiting periods and listed exclusions are common rejection reasons. It’s worth checking that the insurer has applied the right clause.
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Policy lapse or premium issues
A claim during a lapsed period or grace period can be disputed. Payment records and renewal dates matter.
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Unanswered insurer or TPA queries
If a query letter goes unanswered, the claim can be closed. Always respond in writing and keep a copy.
How to file an insurance claim in India
A quick guide to the claim process and the documents usually required. Exact requirements vary by insurer and policy.
Health Insurance Claims
- Cashless: show your health card at a network hospital’s insurance desk; the hospital sends a pre-authorisation request to the insurer or TPA.
- Reimbursement: inform the insurer within the time stated in your policy, pay the hospital, then submit the claim form with original bills.
- Respond promptly to any query from the TPA and track the claim with your claim number.
Documents usually needed
- Claim form and policy copy
- Discharge summary
- Hospital bills and payment receipts
- Investigation and lab reports
- Prescriptions and pharmacy bills
- ID proof and cancelled cheque
Term & Life Insurance Claims
- The nominee informs the insurer about the policyholder’s death as early as possible.
- Submit the death claim form with the required documents at a branch or online.
- Additional documents may be needed for early claims (within the first few policy years) or accidental deaths.
Documents usually needed
- Death claim form
- Original policy document
- Death certificate
- Nominee’s ID, address proof and bank details
- Medical records / hospital certificate
- FIR and post-mortem report (accidental death)
Motor Insurance Claims
- Inform the insurer immediately after the accident or theft and get a claim number.
- For theft or third-party injury, file an FIR with the police.
- The insurer’s surveyor inspects the vehicle; repairs at a network garage can be settled cashless.
Documents usually needed
- Claim form and policy copy
- RC and driving licence
- FIR (theft, third-party or major accidents)
- Repair estimate and final bills
- Photos of the damage
- Original keys (theft claims)
Where to complain if your claim is not settled
If talking to the insurer doesn’t resolve the problem, Indian policyholders have a clear, free escalation path. We help you prepare and follow through at each step.
Insurer’s Grievance Officer
Raise a written complaint with the insurer’s grievance redressal officer. Insurers are expected to resolve grievances within 14 days.
IRDAI Bima Bharosa
If unresolved, register your complaint on IRDAI’s Bima Bharosa portal or call the IRDAI grievance call centre (toll-free 155255).
Insurance Ombudsman
If the insurer rejects your complaint, doesn’t reply within 30 days, or you’re unhappy with the reply, approach the Insurance Ombudsman — free of cost, for claims up to ₹50 lakh.
Insurance claim FAQs
Can you help if my policy was not bought through Smart Network Insurance?
Yes. Share your policy and claim details and our team will review the case and guide you, no matter which advisor or channel the policy was bought from.
My insurance claim is stuck. What should I do first?
Note your claim reference number, check whether the insurer or TPA has raised a query or asked for documents, and request the status in writing. If nothing moves, raise a grievance with the insurer’s grievance redressal officer. Our team can do these follow-ups with you.
My claim was rejected. Can it be reopened?
Often, yes. Ask the insurer for the rejection reason in writing and compare it with your policy wording. Many rejections arise from missing documents, disclosure questions or interpretation of exclusions and can be contested through the insurer’s grievance process and, if needed, the Insurance Ombudsman.
How long does an insurer have to respond to a grievance?
Under IRDAI rules, insurers are expected to resolve grievances within 14 days. If the insurer does not respond within 30 days, rejects your complaint, or you are not satisfied with the reply, you can approach the Insurance Ombudsman.
What is the Insurance Ombudsman and does it cost anything?
The Insurance Ombudsman is a free, government-backed forum for resolving disputes between policyholders and insurers. A complaint must generally be filed within one year of the insurer’s final reply and can cover claims of up to ₹50 lakh.
What details should I keep ready when I contact you?
Your policy number, insurer name, claim number (if already filed), the date of the incident or hospitalisation, and any letters or emails from the insurer or TPA. Even if you don’t have everything, reach out and we’ll tell you what’s needed.
Do you guarantee that my claim will be approved?
No one can guarantee a claim outcome — the final decision rests with the insurer and, in disputes, with the Ombudsman or courts. What we do is make sure your claim is filed correctly, followed up consistently and escalated through the right channels.
Smart Network Insurance provides claim guidance and follow-up support. Claim decisions are made by the insurer as per policy terms and IRDAI regulations.
Don’t let your claim stay stuck.
Share your details and a claim support specialist will call you back.