Itemized bill kyu zaroori hai? / Why insist on an itemized bill?

Lump-sum totals hide inflated line items and non-payable padding — and it's your right to get the breakup. No itemized bill = no way to dispute, no way for the TPA to verify.

Motor claim me surveyor kya karta hai? / What does the motor surveyor do?

Inspects damage BEFORE repair and approves the estimate. Never repair first and claim later (except genuine roadside emergencies — keep those bills). Call the helpline same day.

Accident par FIR kab zaroori hai? / When is an FIR actually required?

Theft claims and significant third-party injury/death claims generally need one. Minor own-damage bumper claims don't — photos + policy + licence + RC suffice. When in doubt, file the FIR; it never harms a genuine claim.

Claim stuck or rejected? Start here — fastest fix first

Most “rejections” are missing-paper cases fixed in days. Read Section 1 before anything else.

The grievance ladder (free at every step)

1
Step 1 — Insurer first
Write to your insurer's grievance cell (email + toll-free on the policy). They must respond — if not resolved in 30 days, or you reject their answer, move to Step 2.
2
Step 2 — Bima Bharosa
File at bimabharosa.irdai.gov.in (or call 155255 / 1800 425 4732, or mail complaints@irdai.gov.in). You get a token number; the insurer must examine and reply within 2 weeks, and you can escalate inside the portal if unsatisfied.
3
Step 3 — Insurance Ombudsman
For individual policies with claim value up to ₹50 lakh: complain to the Ombudsman in your jurisdiction (17 offices across India). Recommendation first; if that fails, a binding Award within ~3 months — the insurer must comply within 30 days.

Open Bima Bharosa Grievance FAQs

Claim stuck or rejected? Do THIS first (fastest fix)

Before portals and lawyers: call the insurer's grievance cell (number on your policy), quote your policy/claim number, and ask for the rejection reason IN WRITING with the exact policy clause number. A surprising share of 'rejections' are actually 'deficiency' cases — one missing document (discharge summary, bills, FIR copy) — fixed in days once you know which paper is missing.

Get the reason in writing with clause number — verbal 'not payable' means nothing.
Ask: 'deficiency or repudiation?' — deficiency = fixable fast.
Keep every email; note dates, names, and reference numbers of every call.

Why claims actually get rejected (real patterns)

The common killers: non-disclosure of pre-existing disease or habits at proposal time; treatment during waiting periods (typically 30 days initial, 2–4 years for named procedures, pre-existing disease waiting); exclusions (cosmetic, OPD unless covered, adventure sports, alcohol-related); sum-insured math (co-pay, sub-limits, proportionate room-rent deduction); and lapsed policies — a single missed renewal can void years of waiting-period credit.

Match the rejection clause against YOUR policy schedule, not the brochure.
Waiting-period credit is precious — never let a policy lapse; use grace period + auto-pay.
Pre-existing disease disclosed + accepted at proposal = payable after its waiting period. Hidden = rejected.

The document kit that prevents 80% of delays

Health claim kit: policy copy, ID proof, pre-authorization form (cashless) or claim form (reimbursement), final hospital bill + itemized bill, discharge summary, prescriptions + investigation reports, pharmacy bills with prescriptions, cancelled cheque / bank details.

Motor claim kit: policy copy, RC, driving licence (valid on accident date), FIR where required, repair estimate + surveyor report, photos from the spot, garage bills.

Itemized bill > lump-sum bill, every single time.
Discharge summary is the single most-asked missing document — collect it before leaving the hospital.
Submit reimbursement claims within the policy's stated window (commonly 15–30 days of discharge).

The grievance ladder: insurer → Bima Bharosa → Ombudsman

Level 1 — your insurer's grievance cell first (always). If unresolved in 30 days or you reject their answer, Level 2 — Bima Bharosa at bimabharosa.irdai.gov.in (helpline 155255 / 1800 425 4732, mail complaints@irdai.gov.in): token-number tracked, insurer must reply within 2 weeks. Level 3 — Insurance Ombudsman (17 offices; individual policies, claim value up to ₹50 lakh): free, recommendation first, then a binding Award in ~3 months that the insurer must honour within 30 days.

Never skip Level 1 — Ombudsman requires you approached the insurer first.
Bima Bharosa complaints are ALSO visible to IRDAI — that's your leverage.
Awards are binding on insurers, not on you — you can still go to court after.

Money-you-could-lose: agents who 'settle' claims for a cut. The entire ladder above is FREE — anyone charging a fee to file your complaint is the problem, not the solution.

Common questions

Cashless kaise lete hai hospital me? / How do I get cashless treatment?

Planned: inform insurer/TPA 48–72 hours before admission. Emergency: stabilize first, inform within 24 hours. Hospital insurance desk sends pre-authorization → approval → insurer settles directly; you pay co-pay + non-payables only.

Cashless deny ho gaya to? / What if cashless is denied?

Get treated, pay, keep EVERY paper, file reimbursement with bills + discharge summary + reports within the policy window (commonly 15–30 days). Then ask the insurer in writing why cashless was denied — the reason matters for escalation.

Claim me kaun se kagaz lagte hai? / Which documents does a claim need?

Health: policy copy, ID, claim form, final + itemized bill, discharge summary, prescriptions + reports, pharmacy bills, bank details. Motor: policy, RC, valid licence, FIR where needed, photos, surveyor report, garage bills.

Discharge summary kyu mangte hai? / Why is discharge summary so important?

It's the single most-asked missing document — it links diagnosis to treatment to bills. Collect it BEFORE leaving the hospital; getting it later takes weeks.

Interim bill kyu mangu? / Why ask for interim bills?

For stays over 2 days, a bill every 24–48 hours keeps surprises small and gives you time to question line items while still admitted — not after a shock discharge bill.

See all 23 questions with search →