How to use Overturn
Overturn checks whether the reason your insurer gave for rejecting a health claim actually holds up, against your own policy and the regulator's rules, and drafts the appeal when it doesn't.
Use it when
- an Indian health insurer rejected a claim, or paid only part of it;
- you have the rejection letter and the policy wording;
- you want to know, before arguing, whether the reason stands up;
- you need a cited letter to the grievance officer, and the Ombudsman dates.
It can't help with
- life, motor or travel insurance;
- medical judgements, such as whether a treatment was necessary;
- an allegation of fraud: talk to a lawyer;
- anything urgent in hospital: call the insurer or TPA first.
Have these ready
- The policy wording. The full terms booklet from your insurer's website or policy email, not just the schedule page.
- The rejection letter (sometimes called a repudiation letter).
- The date your cover first started, including any earlier policy you ported from. It often decides the case.
Step by step
- 1
Start a case
One case per rejected claim. Click New case; it's saved as a draft and renamed after the claim once you review it.
- 2
Add the two documents
The policy wording (the full terms booklet, not just the one-page schedule) and the insurer's rejection letter. Use the + beside the message box: upload a PDF, or photos of a paper letter (one per page, up to 10), or drop files onto the page. Overturn reads each one and works out which is which. Add the discharge summary too if you have it.
- 3
Review the rejection
Click Review this rejection. Overturn reads the whole letter, finds the clause the insurer relied on, checks it against your policy and IRDAI's rules, and runs any date checks (waiting periods, the five-year moratorium) in plain code.
- 4
Answer what it asks
If the answer turns on something your documents don't say, such as the date your cover first started, it asks. Answer in the form; it never guesses a fact you haven't given.
- 5
Read the verdict
Likely challengeable, looks valid, or needs more information. Every point carries a chip: an orange one quotes your own documents, an outlined one quotes IRDAI. Click any chip to see the exact text.
- 6
Send the appeal
On a likely-challengeable verdict, download the appeal letter. Fill in the bracketed details, sign it, and send it to the insurer's grievance officer. The second page gives your dates for the Insurance Ombudsman.
When the rejection looks valid
Overturn will say so. An appeal the documents don't support costs time and rarely ends well, so it never encourages one. You can still ask it questions about the policy, or about what the rejection means for future claims.
Try it first
Sample documents (a policy wording and eight rejection letters, one of them a scan) are in the project's samples folder, with what to answer and what to expect for each.
Information from your documents and IRDAI's rules, not legal or medical advice. · Privacy · Terms