Turning Unfair Rejections Into Binding Approvals
When your insurer says no, we help you say "not yet." Our structured 5-stage dispute resolution framework challenges arbitrary decisions using IRDAI regulations, statutory turnaround timelines, and quasi-judicial Ombudsman escalation.
Our 5-Stage Resolution Journey
Every stage is documented, transparent, and structured to maximize recovery without costly, multi-year court litigation.
Stage 1: Comprehensive Grievance Filing & Intake
24 HoursShare the details of your rejected, delayed, or short-settled claim with our intake desk. We catalog every policy schedule, Customer Information Sheet (CIS), medical record, surveyor report, and insurer communication.
Stage 2: Forensic Policy & Medical/Surveyor Investigation
2–4 DaysOur techno-legal specialists cross-examine the insurer's rejection or deduction grounds against your policy clauses, IRDAI Master Circular protections, the 60-month moratorium rule, and binding judicial precedents.
Stage 3: Formal Representation to the Insurer's GRO
15 Days SLAWe draft and lodge an authoritative written representation with the insurance company's Grievance Redressal Officer (GRO), citing specific regulatory violations and demanding reconsideration within the statutory 15-day window.
Stage 4: Escalation to IRDAI Bima Bharosa & Insurance Ombudsman
Quasi-Judicial ForumIf the insurer fails to resolve the grievance fairly, we escalate via IRDAI's Bima Bharosa portal and prepare your complete complaint dossier (Forms VI & VI-A), written submissions, and hearing arguments before the Insurance Ombudsman.
Stage 5: Binding Award Compliance & Payout Recovery
Direct Bank CreditUnder the Insurance Ombudsman Rules, 2017, an Ombudsman award is strictly binding on the insurer and must be honored within 30 days (with statutory penal interest for delays). We stay engaged until the funds are credited to your bank account.
A Rejection Letter Is Not the Final Verdict
Over 65% of disputed insurance claims stem from technical documentation misunderstandings, misapplied waiting-period exclusions, or automated TPA deductions—not because the underlying claim lacks merit. When re-presented with clinical correlations and IRDAI regulatory citations, wrongful repudiations can be overturned.
Understanding Statutory Escalation Channels
We select the fastest, most effective forum based on your claim amount, policy category, and dispute nature.
| Redressal Forum | Jurisdiction / Claim Limit | Statutory SLA | Legal & Binding Nature |
|---|---|---|---|
| 1. Insurer Grievance Redressal Officer (GRO) | All Claim Values | 15 Days from Complaint | Internal Insurer Review (Mandatory Step 1) |
| 2. IRDAI Bima Bharosa Portal (IGMS) | All Regulated Insurers & TPAs | Real-Time Regulatory Oversight | Regulatory Supervision & Turnaround Enforcement |
| 3. Office of the Insurance Ombudsman | Individual Claims up to ₹50 Lakhs | Award Compliance within 30 Days | Strictly Binding on Insurer (Claimant can appeal further) |
| 4. Consumer Disputes Redressal Commissions | District (<₹50L), State (₹50L–₹2Cr), National (>₹2Cr) | Judicial Adjudication | Binding Judicial Decree (via Empaneled Legal Counsel) |
Disputes Resolved Across All Insurance Verticals
Our multidisciplinary panel represents policyholders across general, life, and health insurance.