Can Insurance Claim Rejection Be Challenged Before Consumer Forum?

Answer:

Insurance claim rejection can be challenged before consumer forum if consumers feel that insurance claim rejection was unfair, arbitrary, without any support from policy terms and conditions or if insurer has resorted to deficiency in service while rejecting consumers claim. Consumer can challenge insurance claim rejection, insurance claim underpayment, unreasonable delay in processing claim by insurer, wrongful deduction in claim amount by insurance company or unfair reliance on exclusion clauses by insurer.

Investigating insurance claim rejection requires consumers to read policy document properly. Consumer complaint should mention policy coverage, if any, policy exclusion if insurer tried to wrongly exclude insurance claim from coverage, terms and conditions for filing insurance claim, disclosure requirements of policy, report of survey agency if insurer sent surveyor to inspect claim subject matter, repudiation letter received from insurance company, medical records if health insurance claim was rejected, repair bills if claim was about damaged property, photographs of damaged property and written communication between consumer and insurer.

NCDRC can entertain appeal against State Commission order in insurance matter if State Commission has wrongly interpreted policy terms and conditions, ignored evidence which consumer submitted alongwith complaint or appeal, applied wrong legal principles, failed to appreciate that insurer resorted to deficiency in service while rejecting claim or if State Commission has passed order which is unsustainable in law.

Lawyer BK Singh and Legal365 guides consumer to look at insurance claim disputes from both facts and legal standpoint. Gathering facts alone will not strengthen your insurance claim dispute case. Strong insurance claim dispute case is built by understanding policy wordings, maintaining claim chronology, collecting documentary evidence and finally explaining to consumer forum how insurance claim rejection has caused loss to consumer.