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How to Prevent Rejection of Health/Medical Insurance Claims?

Medical emergencies can strike anytime and during such difficult times, a health insurance policy can be of great help. This policy insures you against various diseases and that you stay financially secure.  But when health insurance claim gets rejected, it defeats the whole purpose of buying the policy in the first place.

Most of these claims are rejected on legitimate grounds. If the insured takes some precautionary measures and follow the stipulated rules, then there are no reasons why there would a medical claim rejection at all


Here are some of the main reasons why a claim gets rejected:  

1.  Wrong Information:

The insurer offers coverage on the basis of information filled by the proposer in the application form. However, many people let their insurance agents to fill the policy application form on their behalf. As these agents do not have your complete medical history, they fill the wrong information and submit it to the insurer. At the time of claim settlement, if the insurer finds any gap between what is declared and the reality, your health insurance claim can be rejected.

Solution: Fill up the proposal form yourself. Make sure you read the policy terms and conditions carefully and understand them in details. When in doubt, seek clarifications from your insurer or agent.

2.  Pre-Existing Diseases:

In insurance sector, pre-existing ailments are defined as any health condition faced by an individual prior to seeking health insurance. Insurers are reluctant to offer coverage to people who have pre-existing diseases. Even if they offer, they cover these ailments after a waiting period of 3 or 4 years. Thinking that they might not get the insurance, many people do not disclose their pre-existing ailments. However, the insurer can reject your health insurance claim on the ground of non-disclosure of pre-existing ailments.

Solution: Never hide your medical conditions from the insurer. Get medical tests done and submit the report to the health insurance company with complete details.

3.  Policy Lapse:

Insurers settle claims only if the policy is active. Missing the premium due date, may lead to your claim rejection.

Solution: Always renew your health insurance policy on time to avoid any inconvenience. Though insurance companies send renewal reminders, but it is the responsibility of a policyholder to remember the policy renewal date. The insurer also offers a grace period of 15 days to pay premium after the due date. You can renew your policy during this period also to enjoy continuity benefits.   

4.  Delay in Informing the Insurer:

In health insurance, it is important to inform the insurer within 24 to 48 hours of hospitalisation. Any delay in informing the insurer can lead to your medical claim rejection.

Solution: In case of planned hospitalisation, seek the insurer’s approval well in advance. If there is a medical emergency, you can go ahead with the treatment and later inform the insurer within 2 or 3 days of hospitalisation.

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