Regulatory data - Verified IRDAI Annual Report 2024-25 (LifeInsCouncil Mar 30) reports 1 in 12 health claims (~8%) rejected, top room-rent and non-medical, grievances 41% of 1,23,654.
Context
8 percent rejection vs SIT enormous proportion motor fraud are measured differently - rejection is contractual, fraud is intent with FMU/SIT proof.
Implication
Top reasons are contractual, not criminal. 41 percent grievance share is cost of ambiguity - CIS now requires 4 lists upfront.
Action
Match rejection letter to CIS 4 lists. If list not disclosed, ask for FMU category within 15 days citing PPHI.