5 Reasons Why Your Insurance Claim May Get Rejected

Health Insurance

An insurance claim is a boon during any medical crisis that requires hospitalisation. In a cashless claim, your insurer will settle the bill directly with your hospital and you might not have to pay anything from your pocket depending on your insurer’s terms and conditions. 

But what if your health insurance claim gets rejected? This could seriously complicate matters during a difficult phase when you or your loved one is undergoing hospital treatment. Just so you know, it is not uncommon for an insurance company to reject a claim, and often this is because people are not aware of their policy details.

Also read: How To Select An Affordable Health Insurance Plan?

1. Not Disclosing Your Pre-existing Medical Conditions

Health insurance agreements are built on mutual trust between you and your insurer. Just the way you trust the insurer to help you in times of need, similarly, the insurer also expects you to provide accurate information about your medical history. Any mismatch in your medical history could lead to claim rejection. To avoid unnecessary stress during medical emergencies, always provide correct information about your medical condition and history to your insurer, especially while buying a policy. 

2. Not Checking If Your Policy Has Lapsed

Your policy might lapse for several reasons, like:

• If you don’t pay your premiums on time 

To buy and activate a health insurance policy, you need to make an annual or monthly premium payment within the required due date. However, for some reason, if you are unable to pay the premium within the due date, your policy will lapse.  Remember, claims filed under a lapsed policy could get rejected. 

It’s also important for you to know that some insurers provide a grace period of a few days within which you can pay your premium even if you have missed the actual due date. But, we would strongly advise you to ensure you make the premium payments within the due dates to avoid any claim rejection whenever there’s a requirement. 

Secondly, your policy could also lapse if you don’t renew it.

Every health insurance policy comes with a deadline for renewal. Failing to renew your policy on time may also lead to policy lapse resulting in claim rejection. 

So, make sure to pay your premiums on time and renew your policy before the deadline to avoid any unpleasant surprises during claim settlement. 

Also read: What Are Individual Health Insurance Plans?

3. Not Being Aware Of Policy Terms & Conditions

You might be aware of how important it is to read your policy terms and conditions.  In many cases, claims get rejected simply because the policyholder is unaware of the exclusions, waiting periods, sum insured or any other important detail mentioned in the policy document. So, spend some time carefully going through your policy document, and stay informed about every policy detail to avoid the possibility of claim rejection.

4. Not Knowing About The Applicable Waiting Periods

Well, this is actually an extension of the previous point. You might think that you have complete financial protection during any medical emergency from the day you buy a policy, but that might not always be the case. For example, a claim made within the first 30 to 90 days of buying a policy might get rejected due to the initial waiting period clause, as per the policy terms and conditions. Similarly, if you are serving the waiting period for your pre-existing diseases which usually ranges between 1 and 4 years, your claims are likely to get rejected during this time if your hospitalisation is related to your pre-existing condition. So, it’s very important that you carefully read the policy document about different types of applicable waiting periods – the initial waiting period, waiting periods for pre-existing diseases, maternity waiting periods, etc. to avoid the chances of getting your claim rejected. 

Also read: Group Health Insurance Premium Calculator

5. Not Timely Informing Your Insurer About Your Hospitalization

Let’s assume you buy a health insurance policy, and after a few years, you get hospitalized due to a medical condition. However, in all the chaos, you forget to inform your insurer about your hospitalisation in time. Well, this could lead to claim rejection as well.

Most insurers mention in their policy document that they should be informed within 24 to 48 hours about the policyholder’s hospitalisation, and if they fail to do so, and later raise a claim –  such a claim could be rejected. 

So, try to inform your insurer as soon as possible in case of any planned or emergency hospitalisation. Most hospitals have an insurance helpdesk, which could help you with the intimation process.

Also read: 7 Questions To Ask Before Getting A Health Insurance

Final Word 

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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.