Mediclaimswala
Free case review

Claim rejected?We’ve got your back.

Experts from inside the insurance system read your rejection letter line by line and take your case back to the insurer.

Get a free case review
  • Free first review
  • Fee only after you’re paid
  • Help in Hindi and English
  • Fully confidential

What does your letter say?

Sample Health Insurance Co. Ltd.Claims Department, Mumbai
Sample letter
Ref.
SHI/CLM/2026/048213
Date
12 October 2026
Policy no.
2911/HF/004417
Insured
Mr. R. K. Sharma, Jaipur

Subject: Decision on your claim for hospitalisation from 3 to 7 September 2026

Dear Policyholder, we have reviewed the documents submitted for the above claim.

The ailment for which you were hospitalised is a pre-existing disease. The claim is therefore not payable under Clause 4.2 of the policy.

Accordingly, the claim stands repudiated.

If you are not satisfied with this decision, you may write to our Grievance Redressal Officer within 30 days.

Claims ManagerSample Health Insurance Co. Ltd.

How it works

You share the documents. We handle the rest.

Scattered documents gathered into one reviewed case, filed in order and followed up until resolved

  1. Share your documents

    Send your policy, rejection letter and hospital papers on WhatsApp or through the form.

  2. Free expert review

    We study your case and tell you honestly whether it’s worth pursuing.

  3. We build and file your case

    A clear, well-documented representation to the insurer or TPA.

  4. We follow up until it’s resolved

    Replies, reminders and escalation when needed. Our fee is due only after the insurer pays you.

What we do

Whatever stage your claim is stuck at, we take it from there.

  • Rejected claims

    Get a rejected claim reconsidered with a strong, evidence-backed case.

  • Short-paid claims

    Recover deductions that the policy terms don’t justify.

  • Delayed claims

    Follow-up and escalation when a settlement is stuck.

  • Grievance and Ombudsman support

    Help with the insurer’s grievance cell, the Bima Bharosa portal and the Insurance Ombudsman.

  • Group and corporate claims

    Support for HR teams and employees on group health policies.

  • Policy guidance

    Understand exclusions, waiting periods and sub-limits before you claim.

If the insurer still says no

India has a set path for insurance complaints. We take your case up it, one step at a time.

  1. The insurer’s grievance cell

    A written complaint to the insurer, which must acknowledge it within 3 working days and resolve it within 14 days.

  2. Bima Bharosa, IRDAI’s complaint portal

    The regulator’s portal records the complaint and tracks it with the insurer.

  3. Insurance Ombudsman

    Free, for claims up to ₹50 lakh, once the insurer has rejected your complaint or not replied within a month. Apply within a year.

  4. Consumer commission

    When the Ombudsman route is not open to you, or the case needs to go further.

Based on IRDAI rules and the Insurance Ombudsman Rules, 2017. We check which steps and deadlines apply to your case.

Why Mediclaimswala

We help families, senior citizens, employees and the people who look after them.

Policy scheduleFamily floater health policy
Sample
Policy start date
14 March 2022
Waiting period, pre-existing diseases
36 months
Waiting period ends
14 March 2025
Date of admission
3 September 2026

Who we help

  • Families with individual or floater policies
  • Senior citizens and their children
  • Employees with group mediclaim
  • HR teams
  • Hospitals and doctors

Insider expertise

Our team has worked inside the insurance and healthcare sector, so we know how claims are assessed and why they get rejected.

End-to-end handling

From document review to final resolution, one team handles it all.

Honest advice

If your case isn’t strong, we’ll tell you upfront.

Your data stays private

Your medical documents are used only for your case.

Your first case review is free.

If we take up your case, our fee is 10 to 20% of the amount the insurer pays you. You pay it only after that money reaches you.

  • Nothing to pay upfront
  • The exact percentage in writing before we start
  • No hidden charges
Get a free case review

What would you pay?

Our fee (10 to 20%)
₹20,000 to ₹40,000
You keep
₹1,60,000 to ₹1,80,000

Paid only after the settlement reaches you. Your exact percentage depends on the case.

Questions people ask

Can’t find your answer? Ask us on WhatsApp.

My claim was rejected months ago. Can it still be challenged?

Often, yes. Each stage has time limits, so share your documents as soon as you can and we’ll check where you stand.

What do you charge?

The first review of your case is free. If we take it up, our fee is 10 to 20% of the amount the insurer pays you, agreed in writing before we start. You pay it only after the settlement reaches you.

Do you guarantee my claim will be approved?

No one can honestly guarantee that. The final decision rests with the insurer or the Ombudsman. What we promise is an expert, well-prepared case and steady follow-up.

Can I approach the insurer or Ombudsman myself?

Yes. Policyholders can approach the insurer’s grievance cell, the IRDAI Bima Bharosa portal and the Insurance Ombudsman directly, free of cost. We help people who want experienced support through that process.

What documents do I need?

Usually your policy copy, the rejection or settlement letter, the discharge summary, hospital bills and any letters exchanged with the insurer. Send what you have and we’ll tell you if anything else is needed.

The insurer is sitting on my claim. Is there a deadline?

Yes. Once an insurer has all the documents it needs, it must settle within the time IRDAI sets, and a late settlement carries interest at 2% above the bank rate. We chase the claim and escalate when the deadline passes.

Which insurers do you work with?

We help with claims from public and private health insurers and TPAs across India.

Is my information kept private?

Yes. Your documents are used only to work on your case and are never shared without your consent.

Don’t give up on your claim.

Tell us a little about your claim and we’ll get back to you on WhatsApp.

Get a free case review

After sending, you can share your documents in the same WhatsApp chat.

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