Bima Worker

Your health claim deserves a fair explanation. Bima Sarthi gives you one. Meet Asha. She is made up, but her letter is painfully typical. Two nights in hospital, a claim of Rs 2,50,000, and then a polite letter from her insurer: claim repudiated, "pre-existing disease and non-disclosure". One line of reason. Zero rules quoted. Her policy has been renewed without a break since 2019, and the insurer says the waiting period is 48 months. Is that even allowed? To find out, Asha would need three documents side by side: the letter, the policy it leans on, and the IRDAI regulation behind it, plus a calendar to work out which dates matter. That is slow, and nobody should have to do legal homework while worrying about a hospital bill. In 2023-24 the Insurance Ombudsman received 31,490 health-insurance complaints. That is a lot of Ashas. What Bima Sarthi does: 1. Reads your documents. Upload a PDF or a phone photo. Meta's Muse Spark Open pulls out each fact with the exact words and page it came from. 2. Asks you to confirm. Anything the reader is unsure about is highlighted for you to check, and you can step back to any stage without losing a thing. 3. Applies written rules. A deterministic rule engine checks the facts against rule cards built from IRDAI regulations. Each card quotes the regulation word for word, with its page and the date it came into force, and goes live only after a person approves it. Every finding is Challengeable, Consistent or Need info. If a fact is missing, it asks. It never guesses. 4. Tells you what to do next. You get: - the quoted rule beside your letter's own words; - a one-picture summary (counts, not odds); - real consumer-court cases with the same rejection reason, and who won them (for pre-existing disease: the policyholder, 3 out of 3); - your complaint deadlines on a timeline; - a step-by-step plan, and a grievance letter ready to send. All of it in English and Hindi. Bonus: a schemes finder for farm workers in Maharashtra. Answer four questions and see which government schemes fit, what each one pays, and how a claim on it can fail. The house rules: rules decide the verdict, and models only read your documents. Everything on screen traces back to a stored source and page. Your documents are deleted after the result, or within an hour. And it is a rules check, not legal advice, so Bima Sarthi will never promise Asha that she will win. It will make sure she knows whether to push back, and exactly how.