Overview
When you buy a product, the first thing that comes to your mind is who will help you if the product is not what you had expected or you had difficulty with it? The answer to this question is simple, the company you bought it from. As a consumer, you trust the company that they will help you if you are unsatisfied. However, when it comes to insurance, the circumstances can differ. Insurance companies are there to help, but the situation may vary.
Insurance is a contract of trust, where both parties put their utmost faith in each other that the information they provide is accurate. However, as a policyholder, you face challenges due to the numerous terms and conditions in insurance policies. These terms often require attention during purchase. Sometimes, when policyholders request a claim, it may be denied, causing distress. While many denials are valid, many times the policyholder is also correct. This can lead to disputes over who is right and wrong
Insurance companies don’t aim to reject your claims on purpose. Sometimes, you believe you’re right and want to fight for the money you’ve paid as premiums year after year. Today, we’ll discuss various reasons why insurance claims can be rejected, but how you can still contest and succeed.
Reasons for Health Insurance claim rejection
- Delay in claim intimation/ submission of documents can arise from multiple factors, such as lack of familiarity with terms and conditions, stress during urgent medical emergencies, and unexpected events. Regardless of the inevitability of your delay’s cause, such delays can result in the rejection of your claim.
- Hospitalization not Required – Numerous instances occur where doctors advise hospitalization, leaving patients with no choice but to undergo the prescribed procedure. However, the insurance company can reject the claim stating that hospitalization was unnecessary.
- Misrepresentation of Facts – Insurance companies use the details you give them to check if your claim is valid and decide how much to pay you. They might only accept your health claim if the information is correct or clear.
- Required documents not provided – When you file for a health claim, the insurance company wants you to provide all the relevant documents. The insurance company can deny your claim even if you miss one document.
- Waiting Periods – The insurance contract has waiting periods for specific conditions to stop people from getting insurance just for quick coverage of existing illnesses. Unfortunately, many people lack this knowledge and end up facing health claim rejections.
- Admitted for Diagnostic Purposes – You may go to a hospital for diagnostic purposes but get hospitalized on the doctor’s advice. In this situation, the insurance companies may reject the claim stating that you only went for a diagnosis.
Reasons for Life Insurance claim rejection
- Non-Disclosure or False Information – One of the most common reasons a life insurance claim is denied is non-disclosure or providing false information. When applying for a life insurance policy, being completely honest about your medical history, lifestyle, and other relevant details is crucial.
- Failure to Disclose Existing Insurance Policies – you must disclose any existing insurance coverage. Not providing accurate information about your insurance policies can result in the rejection of the claim.
- Non-updation of Nominee Details – The nominee is the person who will receive the insurance benefits in case of your demise. Life circumstances change over time, and relationships may evolve, making it necessary to review and update your nominee details accordingly. Please do so to avoid a life insurance claim rejection.
Insurance Samadhan Can Help
In all of the above cases, you can still fight for the claim if you feel that you have provided all the correct information to the insurance company with the help of Insurance Samadhan. We are here to help you out with our expert assistance. We have a total of 100+ years of experience in the insurance industry.
Our team of experts specializes in resolving insurance-related grievances and advocating for policyholders’ rights. We have helped 15,000+ people in resolving insurance claim-related complaints. We are always here to help you!
Bottom Line
The fact that your insurance claim can get rejected is true but if you want you can fight for your rights. Insurance Samadhan can offer you expert advice that can get your hard-earned money back. So what are you waiting for? If your claim got rejected, feel free to contact us.
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