In recent years more and more people have become aware of the importance of buying a health insurance plan to secure themselves and their families against medical emergencies. However, one needs to remain well informed about health insurance plans, as lack of proper knowledge can lead to the rejection of your insurance claims. There are a number of reasons why your health insurance claim can be rejected.
It’s important to go through the terms and conditions of a health insurance plan in detail before selecting the right plan as per your need. You should check the kind of illnesses covered and the expenses for which you can get a reimbursement.
Incorrect information: While filling out the health insurance application, applicants must ensure that they fill up the form with all the accurate information including personal details, and health issues (if any). Any sort of incorrect detail can result in the rejection of your health insurance claim.
Hiding medical history: Applicants must disclose all the important details about their medical history. While people mostly avoid revealing such details, it is important to do so because the insurer can reject the application in case of missing details.
Non-renewal: Not renewing the health insurance policy at regular intervals can result in the policy lapsing. In such a case, if the insured needs sudden coverage during this gap, the claim will be rejected.
Besides these, a few other reasons behind rejection of a claim could be claim amount exceeding sum insured, raising a claim within waiting period and not informing the insurer at the time of getting admitted to hospital, among others.
In case, your health insurance claim is rejected, you can follow the given measures to ensure that your claim application gets approved.
- The health insurance policy holder should begin by properly studying the reason behind the rejection of the claim and the recommended course of action.
- Next, approach the grievance redressal officers (GRO) of the concerned health insurance company and file a complaint. In case this doesn't work, policyholders can approach the ombudsman.
- As the last alternative, policyholders can also approach the appropriate legal forums.
- Reach out to the Grievance Redressal Cell of the Consumer Affairs Department of IRDAI by calling their toll-free number 155255 (or) 1800 4254 732.
- You can send an e-mail to complaints@irdai.gov.in.
- In case of rejections, policyholders can also approach the consumer court.
