How to handle a health insurance claim
Five rules that cover most of it, then the detail if you want it.
5 rules for every health insurance claim
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Keep important communication in writing
If it matters to your claim, put it in an email. A conversation leaves no record.
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Reply on the same email thread
One thread keeps the whole story in order, with the claim number in the subject.
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Respond to every insurer query
Answer each point, in the same order it was asked. A part-answer usually means another query.
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Keep proof of everything you submit
The covering email, the attachment, the acknowledgement and the date.
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If you need help responding, forward it to ClaimSaathi
Send the complete communication and we will help you prepare the reply.
The full checklist
Everything worth doing on an ordinary claim, in one place.
- Reply on the same email thread
- Keep the claim number in the subject line
- Respond to every insurer query
- Answer every point raised, in the same order
- Keep copies of everything you submit
- Keep acknowledgements and delivery confirmations
- Save all correspondence, in and out
- Record the dates: admission, discharge, submission, replies
- Follow up every important phone call by email
- Be factual, and stick to what your documents show
Email templates you can adapt
Ordinary, polite emails — not legal notices. Replace anything in square brackets and delete what does not apply.
Dear Sir / Madam,
Further to our telephone conversation today, I understand that you have requested the following information/documents in connection with the above claim:
1. […]
2. […]
I am recording the same by email for clarity and reference. Kindly confirm whether my understanding is correct.
Thank you.
[Your name]
Dear Sir / Madam,
With reference to your email dated [date], my point-wise reply is as follows:
Query 1: [the query in short]
Reply: [your answer]. Please refer to [document name], attached.
Query 2: […]
Reply: […]
Kindly acknowledge receipt and let me know if anything further is required.
Thank you.
[Your name]
Dear Sir / Madam,
Against a claimed amount of ₹[amount], an amount of ₹[amount] has been settled.
Kindly provide a line-wise breakup of the amounts deducted, stating against each item the specific clause of the policy or the reason relied upon.
Kindly acknowledge receipt of this email.
Thank you.
[Your name]
Dear Sir / Madam,
I have received your letter dated [date] rejecting the above claim on the ground that [the stated ground].
I request you to reconsider, for the following reasons:
1. [Fact], as recorded in [document name, attached].
2. [Fact], as recorded in [document name, attached].
I am not disputing the terms of the policy. My submission is that, on the facts on record, the ground stated does not apply to this claim.
Kindly review the matter and convey your decision in writing.
Thank you.
[Your name]
Check before you send
A template cannot know your policy or what your insurer has written. Check every line against your own documents. If you would like help adapting one, send us the details — it is free.
A little more detail
Open only what you need.
Answer every point, in order
If the insurer asks five things, reply to five things, numbered the same way. If a document supports a point, name it and attach it.
Stick to what your documents show
Write only what you can support. An overstated line can weaken an otherwise sound response, and it stays on the record. Never alter or re-type a medical or insurance document.
Keep one claim file
One folder, in date order: policy papers, hospital records, bills, the claim form, and every email in and out. Name files with the date first, such as 2026-03-14-discharge-summary.pdf, so they sort themselves.
Read it once more before sending
Check the names, dates, amounts and claim number. Once sent, it is part of your claim.
What to keep in your claim file
| Section | What goes in it |
|---|---|
| Policy | Policy schedule, terms and conditions, renewal notices. |
| Claim | Claim form, covering letters, acknowledgements, cashless pre-authorisation papers. |
| Hospital | Discharge summary, itemised final bill, payment receipts. |
| Medical | Test reports, prescriptions and doctor's notes relevant to the issue. |
| Emails | Every email to and from the insurer or TPA, in date order, with attachments. |
| Notes | A one-page timeline, and a note of every phone call — who, when, what was said. |
Keep the file private
It holds medical information. Store it where only you can reach it, and share only what a particular request needs.
If the matter has to be escalated
First make sure the basics are complete: every query answered, every document submitted with proof, and a written request for the specific reason or clause being relied upon. Many disputes close at that stage.
If it still does not move, insurers in India publish a grievance procedure — usually in the policy wording and on their website — setting out whom to write to and the timelines that apply. Read your own policy's procedure rather than a general description of one. Beyond that, policyholders may have recourse to external forums such as the Insurance Ombudsman and the consumer redressal system; eligibility, procedure and time limits are set by those bodies and do change, so check their current requirements before proceeding.
We can help you prepare grievance or escalation correspondence where appropriate. We do not represent policyholders before any insurer, ombudsman, forum or authority, and nothing here is legal advice. Where you need a lawyer or another professional, please consult one.
Not sure how to answer your insurer?
Forward us what they sent. We will help you prepare the reply — free.