Two policyholders. One problem. Two very different outcomes.
Meet Riya and Neel.
Both submitted insurance claims on the same day—Riya for a hospitalisation reimbursement,
and Neel for his car accident damage. Both faced a delay in claim process. But while Riya’s
claim dragged on for over a month with no end in sight, Neel had his money in hand without
a headache.
The difference? Riya went it alone. Neel had a subject matter expert by his side from the very
beginning.
This blog isn't just another guide—it's your behind-the-scenes look at how claim delays
happen, how they can be tracked, and how to tip the scales in your favour. With real insight
and expert-backed strategies, we’ll show you exactly why a helping hand changes everything.
1. The Timelines
Day 1: Submitting the Claim
Riya filed her documents online. She got an auto-generated acknowledgement but didn’t
think to screenshot or save it. Neel’s advisor walked him through the submission, ensured all
documents were complete, and helped him note down the reference number, helpline, and
escalation contacts.
Day 4–7: Tracking the Claim
Riya tried the insurer’s online portal. It showed “under process.” She waited.
Neel’s expert tracked the claim daily, cross-referencing with internal escalation contacts and
ensuring his claim moved.
Where you can track your claim:
● Online portals (insurer dashboard)
● Mobile apps (many offer push updates)
● Customer care helpline (with claim ID)
● Email support (always keep email chains)
Day 10: The Silence
Riya hadn’t heard anything. She assumed they were “working on it.” She didn’t realise that
her discharge summary was missing a stamp—a tiny error that paused the process.
Neel? His expert had pre-checked every document and spotted such gaps before submission.
His file was clean, complete, and ready to go.
What delays most claims?
● Missing or incorrect documents
● Discrepancies in hospital or garage bills
● Wrong details or contact info
Day 17: Escalation Point
Riya, now anxious, emailed the insurer. No reply. She called again and again—finally got a
bot reply. Still, no resolution.
Neel’s advisor had already followed up via email and customer care. When they spotted no
movement on Day 10, they escalated the case through the insurer’s internal grievance
redressal system. By Day 17, Neel’s claim was approved.
Day 25: Two Realities
Riya finally got a call: Her claim was rejected due to an “incomplete medical file.”
Disheartened, she didn’t know where to turn.
Neel? He’d already received his claim settlement, with a proper breakup and confirmation
emails.
2. The Real Game-Changer: Subject Matter Experts
Navigating insurance claim-related issues, from delays to claim rejection, isn’t just about
knowing the rules—it’s about knowing how companies work.
Experts understand:
● Which documents carry weight
● Which departments handle what
● What timelines are realistic (and when to push)
● How to reframe your case if faced with claim rejection
They’re not just middlemen—they're your guide, buffer, and advocate in a system designed to
exhaust you.
3. If You’re Riya: What Can You Do Now?
All hope isn’t lost if your claim is rejected or stuck:
1. File a written grievance with your insurer’s Grievance Redressal Officer
2. Escalate through the IRDAI IGMS portal
3. If unresolved in 30 days, approach the Insurance Ombudsman (especially for claimrejection-related issues under ₹50 lakh)
But here's the truth: This can be overwhelming.
So if you're stuck in a web of emails, delays, or unclear jargon, consider getting help.
Someone who knows the playbook, the pressure points, and how to get things moving.
Final Thoughts: Choose Your Path Wisely
The difference between Riya and Neel wasn’t their claim type or company. It was access.
Riya waited, trusted the system, and got buried in bureaucracy. Neel had someone who spoke
the system’s language and navigated it with precision.
So here’s your choice: wait endlessly—or walk into the system with someone who knows
exactly how to get you out the other side.
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