Legal Notice for Insurance Claim Rejection Format

[ON THE LETTERHEAD OF THE ADVOCATE]

By Registered Post A/D & Email

Date: [DD/MM/YYYY]

To,
The Grievance Redressal Officer / Head – Claims,
[Name of Insurance Company]
[Address]

Subject: Legal notice against wrongful [rejection / partial settlement / non-settlement] of claim no. [Claim Number] under policy no. [Policy Number].

Sir/Madam,

Under instructions from my client, [Policyholder / Nominee Name], of [Address], I serve upon you the following notice:

1. That my client [holds / is the nominee under] [type of policy] no. [Policy Number] issued by you, valid from [DD/MM/YYYY] to [DD/MM/YYYY], for a sum insured of Rs. [Sum Insured], and all premiums have been duly paid.

2. That on [DD/MM/YYYY] [describe the insured event — hospitalisation / accident / death / loss], and my client intimated you on [DD/MM/YYYY] and submitted claim no. [Claim Number] with all documents sought, for Rs. [Claim Amount].

3. That by letter dated [DD/MM/YYYY] you [rejected the claim / settled only Rs. ___] on the ground that [quote the ground].

4. That the rejection is wrongful because [choose / adapt]:
   (a) the alleged condition was [not pre-existing / disclosed in the proposal form / not causally connected to the claim];
   (b) the exclusion relied on does not apply on its terms;
   (c) the delay in intimation, if any, was due to [reason] and caused no prejudice to you;
   (d) [for life policies] the policy has been in force for more than three years and cannot be called in question under Section 45 of the Insurance Act, 1938;
   (e) no reasoned decision was given within the time prescribed by IRDAI regulations.

5. That your action amounts to deficiency in service under the Consumer Protection Act, 2019.

I therefore call upon you to settle the claim and pay Rs. [Claim Amount / Balance Amount] with interest at [rate]% per annum from [DD/MM/YYYY], within fifteen (15) days of receipt of this notice, failing which my client shall approach the Insurance Ombudsman and/or the Consumer Commission for the claim amount, interest, compensation and costs.

[Advocate Name]
[Enrolment No. / Contact]