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What to do When a Claim is Rejected

Claim is Rejected
If your claim is rejected, the insurance company must give you the reasons for rejection. You can find out why your claim was refused. Insurance companies are required by the IRDA to give reasons for rejecting claims. The complaint and response letter of the insurance company can be used to find out the reasons why your claim has been refused. More straightforward disputes may be resolved, or incorrect decisions may be overturned when the matter is considered from a fresh perspective. You may also be given a more detailed explanation of the reasons behind the original decision, and understand why the claim had been rejected correctly. Following are mainly the reasons for life insurance rejection by the insurance companies. 

  • Generally claims are refused by the insurers due to the policy holder not fulfilling the legal conditions.

  • In certain cases the insurer or company will refuse to pay the insurance amount. This mainly happens on suicide case of the ensured. A Life insurance company will refuse to repay the claim on the suicide of the insured within a specified period generally 1 year.

  • Violation of good faith, most insurance companies enter into long term contracts with their clients. Hence it is important that accurate data regarding age, health, financial conditions and other aspects are provided in advance.

  • Premiums are to be paid on important, timely payment will help your policy be on a clean front. Most of the Insurance companies do provide a grace period of a month, after that the policy is confiscated.

  • Proper documentation is one of the primary reasons that an insurance claim could be rejected. The following points should be covered & all paper work should be duly made in writing and duly signed by the nominee, a) Name of the insured, b) Policy number, c) Date of death, d) Cause of death.

So what to do if your insurance claim is rejected for a reason or the other? To begin with, one has got to follow a set of procedures. First and foremost get the death certificate of the insured as early as possible and provide it to the insurer. Call up your insurance representative and ask his assistance to get all necessary documents filled accurately. Your agent can act as an intermediary between you and the company. In case you don’t have an agent contact the insurance company directly. Submit a certified copy of the death certificate to your insured. Once this is done a settlement is issued shortly.

Written By: PolicyBazaar - Updated: 19 August 2020
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