Insurance

Practice Areas

Insurance coverage is supposed to provide peace of mind when things go wrong. However, in many cases, policyholders face challenges in getting the compensation they deserve. If you’ve been denied a claim, underpaid, or treated unfairly by an insurance company, you don’t have to face this fight alone. Our experienced attorneys are here to help you navigate the complexities of insurance claims and disputes.

Types of Insurance Claims We Handle:

Health Insurance Claims: Denials of medical treatments, coverage disputes, and insurance policy interpretation.
Auto Insurance Claims: Denied or underpaid claims related to accidents, property damage, and bodily injury.
Homeowners Insurance Claims: Disputes over property damage, fire claims, water damage, or theft claims.
Life Insurance Claims: Denials of death benefits, policy disputes, or bad faith practices by insurers.
Disability Insurance Claims: Denied claims or issues related to long-term or short-term disability benefits.
Commercial Insurance Claims: Coverage issues and disputes affecting businesses, including liability and property damage claims.

What to do if your insurance claim is denied

Insurance companies may wrongfully deny claims or delay payments, leaving you struggling to cover expenses. If your insurance claim has been denied or is taking longer than expected, you may have grounds to appeal the decision or pursue legal action. Our team of insurance dispute lawyers can help review your case and advise you on the best course of action.

Understanding Insurance Bad Faith

Insurance companies have a legal obligation to act in good faith when handling your claims. If they act in bad faith—delaying or denying legitimate claims, offering less than your policy entitles you to, or failing to communicate properly—you may be entitled to compensation beyond your original claim.

Signs of Bad Faith Insurance Practices:

Unreasonable delay in processing your claim.
Offering a settlement lower than the policy's value.
Denying a claim without a valid explanation.
Failing to investigate your claim properly.
Misrepresentation of the terms or benefits of your policy.

If you suspect your insurance provider is acting in bad faith, contact our legal team to learn about your options for holding them accountable.

Insurance Coverage Disputes: What You Need to Know

Disputes over insurance coverage can arise when there is a difference in understanding of what is and isn’t covered by your policy. These disputes often require expert legal assistance to interpret policy terms and negotiate with insurers on your behalf.

We assist with:

Policy Interpretation: Clarifying the terms and coverage of your insurance policy.
Underinsurance: When your coverage limits are insufficient to fully cover your losses.
Exclusions and Riders: Disputes over specific exclusions or endorsements in your policy.
Appeals: Helping you appeal denied claims or insufficient payouts.

ACTS & RULES ON INSURANCE CLAIMS AND DISPUTES

Insurance Act, 1938

The core legislation governing insurance in India, including provisions for:

Timely claim settlement
Reporting obligations of insurers
Powers of IRDAI to penalize for delays or misconduct in claim handling

IRDAI (Protection of Policyholders’ Interests) Regulations, 2017

Issued by IRDAI, this is the key regulation for handling claims and disputes.
Key Provisions:

Timelines for Claim Settlement:
- Life insurance: Within 30 days from receipt of all documents
- Health/general insurance: 30 days, or 15 days if a third-party administrator (TPA) is involved
Delay Penalty :
- Insurer must pay interest at 2% above the bank rate in case of delay
Rejection of Claims:
Must be communicated with reasons
Rejections require approval by a senior official

Insurance Ombudsman Rules, 2017

Created under Section 24 of the Insurance Act, 1938 to resolve disputes outside courts, affordably and quickly.
Key Features:

Covers complaints related to:
- Non-settlement or delay in claims
- Partial settlements
- Misrepresentation, policy service issues
Jurisdiction:
- Only for individuals and small businesses (claims up to ₹30 lakhs)
Time Limit:
Complaint must be filed within 1 year from the insurer's rejection
Binding on insurer if accepted by policyholder

Consumer Protection Act, 2019

Created under Section 24 of the Insurance Act, 1938 to resolve disputes outside courts, affordably and quickly.
Policyholder Rights:

File a complaint for deficiency in service
Claim compensation for unfair trade practices
Available forums:
- District Commission (for claims up to ₹50 lakh)
- State Commission (₹50 lakh to ₹2 crore)
- National Commission (above ₹2 crore)

IRDAI (Health Insurance) Regulations, 2016

Specific to health insurance claims:

Standardization of terms like pre-existing diseases, exclusions.
Cashless claim settlement through TPAs or directly by insurers.
Mandatory grievance redressal system in all health insurers.

IRDAI Grievance Redressal Mechanism (IGMS)