Help & Grievance Redressal
Customer assistance, IRDAI compliance disclosures, grievance channels, and privacy information.
Frequently Asked Questions
How does Claim Ji answer questions about insurance policies?
Claim Ji searches strictly against approved, published policy wording sections using Retrieval-Augmented Generation (RAG). Every answer cites the verbatim section (§) so you can review the contractual text directly. Claim Ji never invents or guesses coverages.
Can Claim Ji approve or deny my claim directly?
Claim Ji provides real-time information, guidance on required evidence, and status updates. While deterministic rule engines evaluate eligibility according to IRDAI guidelines, decisions above threshold or requiring judgment are evaluated and signed off by licensed human claims adjusters.
What is the difference between cashless and reimbursement claims?
In cashless claims at network hospitals, the hospital coordinates directly with the Insurer/TPA for pre-authorization. In reimbursement claims, you settle the hospital bills directly and submit discharge summaries, invoices, and payment receipts to the insurer within 15 to 30 days of discharge.
How do section anchors (§) work on ClaimKavach?
Section anchors (such as §-2-1) represent immutable paragraph numbers within the official policy wording document. Clicking any citation link takes you directly to the exact clause in the Policy Wording Viewer.
What should I do if my claim is disputed or delayed?
You can file a formal grievance with the Insurer's Grievance Redressal Officer (GRO). If the grievance is not resolved within 30 days or the resolution is unsatisfactory, you may escalate your complaint to the Insurance Ombudsman or the IRDAI Bima Bharosa portal.
Grievance Redressal Mechanism (IRDAI Clause 30)
In compliance with IRDAI Protection of Policyholders' Interests Regulations:
Customer Support Desk
Live chat with Claim Ji or email: support@kavach-demo.in (Response within 24 hrs).
Grievance Redressal Officer
Escalate to the GRO: grievance@kavach-demo.in. Written resolution within 14 days.
Insurance Ombudsman
Refer to Insurance Ombudsman under Insurance Ombudsman Rules 2017 if unresolved.
Digital Personal Data Protection (DPDP) Privacy Notice
Under the Digital Personal Data Protection Act, 2023 (DPDP):
Data Fiduciary: ClaimKavach operates on behalf of participating insurer organisations. Personal data collected during chat, document upload, and claim registration is processed strictly for policy interpretation and claims administration purposes.
Purpose Limitation: Uploaded medical records and claim evidence are processed in isolated quarantine, scanned for security, and stored encrypted with strict Row-Level Security (RLS). We never train foundation AI models on your private medical data.
Data Principal Rights: You have the right to request access, correction, or erasure of your personal data, subject to IRDAI-mandated statutory retention obligations (claims and financial records retained for 7 years).
For privacy inquiries or data rights requests, contact our Data Protection Officer at: dpo@claimkavach.charviam.com.