It may have happened to you or someone you know that the health insurance claim has been rejected. Why do medical insurance companies reject claims? There are 4 major reasons for this. You should also know this so that you can avoid losing lakhs.
You must have also taken medical insurance for the huge expenses ranging from hospitalization to medical. You choose a medical insurance for yourself very thoughtfully and keeping all the aspects in mind. But it also happens many times that when the need arises, the insurance companies reject your claim.
Now imagine how much trouble you will have to face when your mediclaim policy is rejected and you have to bear the cost of treatment from your own pocket. This can be a scary truth for anyone. This will not only cause stress but will also have to bear the financial burden.
According to IRDAI data, in the financial year ended in March 2024, insurance companies rejected health policy claims worth Rs 26000 crore. This figure is increasing every year. During the year 2022-23, this figure was 19.10 percent. Let us know why health insurance companies reject claims?
Why medical claim is rejected:
Claiming during the waiting period: Every plan has a waiting period. If you claim during the waiting period, there is a high possibility that the claim will be rejected because you are not yet eligible for it.
Hiding information about pre-existing diseases: One of the major reasons for the claim being rejected is that you have not disclosed your pre-existing diseases while buying the policy. If you do not disclose your illness while buying the policy, your insurer may reject the claim if it is found out later.
Lapsed insurance policy: If your insurance policy has lapsed or you have not been able to pay the premium, your insurer may deny you medical coverage.
Delay in filing claim: Every insurance policy has a certain time limit for filing a claim. If you are unable to file a claim within the stipulated time, the insurer may reject your claim.
Claiming more than the sum assured: If you have already made claims equal to the sum assured of your policy in a year, then you will not be able to make any more claims during that year. In such a situation, the insurer can reject your claim. If you are making a claim for the first time, but the amount of the claim is more than the sum assured, then the company can reject your claim.
