Missed insurance claim submission deadline? Don't worry, you are still eligible for reimbursement. Here's why

Consider this: After your loved one’s hospitalisation, you are occupied with follow-ups, medicines and diagnostic tests. In the process of completing the long list of errands, you end up filing the claim a few days past the insurance company’s stipulated 90-day deadline for document submission. The insurer rejects your claim, citing the policy’s terms.

Submission delayed

Mumbai resident C.P. Ravindranath Menon, an employee of the Export- Import Bank of India, and his wife, Sindhu, faced a similar predicament in 2022. Their health insurance claims under the employer’s group health cover were rejected by public sector major, United India Insurance. Amounting to Rs 1.13 lakh, these claims pertained to the policy period between 1 April 2021 and 31 March 2022. Menon’s writ petition and the insurer’s correspondence indicate the claims included domiciliary and outpatient department (OPD) expenses. The company argued that as per the terms of the policy, bills more than 90 days old cannot be reimbursed. The Bombay High Court ruled in favour of the petitioners on 20 April and asked the insurer to reimburse the amount within eight weeks, and also pay interest at 6% per annum. To be sure, the insurance company has the option of approaching the Supreme Court, appealing against the order.

“The insurance policy provided a 90-day cut-off and various other cutoff timelines. Claim submission was beyond these, and the insurer enforced these cut-off timelines, saying the right to claim was extinguished. These clauses have been held to be void by the judgment in view of Section 28(b) of the Contract Act and the Supreme Court judgment in the Oriental Insurance case,” says advocate Subit Chakrabarti of law firm Vidhii Partners, who represented Menon in the case.


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Lawyers contend that a delay in paperwork cannot invalidate a legitimate claim. “The expenses were well within the coverage, including the post-hospitalisation window. The rejection was solely on the ground of delay in submission, which the court rightly held cannot defeat a valid claim. The key point here is that the genuineness and admissibility of the claim were never in doubt,” says Sulaiman Bhimani, Founder & Managing Partner, The Law Suits, and President, Citizens Justice Forum.

Companies’ approach of relying on internal timelines for accepting claim documents, when such clauses effectively extinguish substantive rights, has been called into question. “By invoking Section 28 of the Indian Contract Act, the court has made it clear that contractual conditions which unreasonably restrict enforcement of legitimate claims are void,” says Shiv Sapra, Partner, Kochhar & Co.

Do note that the order relates only to delayed submission and not to claims falling outside the policy period. “The judgment clearly proceeds on the footing that the repudiation was solely on account of delayed submission of claims and documents. The court neither expands nor relaxes the scope of policy coverage; it merely invalidates the insurer’s reliance on a contractual clause that extinguishes the insured’s right upon expiry of a stipulated period,” says Supreme Court advocate Tushar Kumar.

IRDAI’s measures for filing delay

The Insurance Regulatory and Development Authority of India’s (IRDAI) Protection of Policyholders’ Interests regulations, 2024, are also clear that insurers should not reject or close claims merely for want of documents or delayed intimation. “Even independent of Section 28 of the Contract Act, blanket repudiation of health claims solely for delayed filing sits uneasily with IRDAI’s fair claims philosophy. Regulatory timelines are meant to streamline administration, not become traps for forfeiture,” says Sapra.

The IRDAI had, even in 2011 and 2017, issued circulars asking insurers to refrain from mechanically rejecting genuine claims on the grounds of late submission of documents, especially if the delay was due to unavoidable reasons.

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“As per IRDAI, the timeline is necessary for maintaining discipline, but if the claimant provides a valid reason for the delay, such claims should be considered,” says Shilpa Arora, Co-founder and Chief Operating Officer, Insurance Samadhan, a firm that assists customers in escalating their grievances.

She adds that if free hand were to be given on timelines, all policyholders would take advantage of the lenient rules.

Implications for future claims

Bhimani feels that the judgment will send a strong message to insurers. “It underscores that mechanical repudiation of claims is unsustainable. Insurance is a contract of indemnity—it must serve its purpose, not be reduced to a tool to reject genuine claims on procedural grounds.”

Insurers may now have to relook their terms and conditions. “They may have to revisit the enforceability of such terms and conditions that purport to extinguish rights upon expiry of prescribed timelines, as such stipulations are susceptible to invalidation under Section 28,” says Kumar.

From policyholders’ perspective, it is now clearer than before that, barring any prejudice or fraud, they do not lose the right to claim settlement merely on account of delay in claim intimation or submission.

“The wider implication is that insurers will now need to assess claims on merits rather than hide behind technical delay objections, especially in health insurance where policyholders are often dealing with medical distress rather than paperwork,” says Sapra.

Arora of Insurance Samadhan, however, is less optimistic. “Insurers will continue to refuse to pay the claim at the first instance by referring to the terms of the contract. Only well aware claimants will escalate the matter and are likely to obtain claim settlement. However, in our experience, only about 20% of policyholders take this route,” she says. Aggrieved policyholders need to be aware that such escalations will not always yield immediate results as the litigation process – be it via ombudsman offices or courts – can be time-consuming. For example, the verdict in Menon’s case, which pertains to 2022, was delivered in 2026. For any grievance against your insurer, your first stop ought to be the company’s internal complaint resolution mechanism, including writing to the designated grievance redressal officer. Next, you can file a complaint through IRDAI’s Bima Bharosa portal. You can also approach the insurance ombudsman directly, either online or by physically submitting your complaint at the quasi-judicial body’s offices located in most major cities. Finally, if all else fails, you can knock on the doors of the consumer courts and later higher courts, as the Menon couple did.