Filing a health or life insurance claim should ideally be a straightforward process—submit documents, verify details, receive your claim amount. But many policyholders face a frustrating loop: the insurer keeps asking for more documents, even after you have submitted them multiple times. Weeks or even months go by, and in some cases, the claim is eventually rejected citing “insufficient documentation” or “non-submission of required papers.”
This situation is more common than people realize. Many families are left confused and helpless, especially when the medical treatment has already caused financial strain. However, it is important to understand why this happens and what you can do to protect your rights.
Why Does This Happen?
- Lack of Standardized Documentation:
Hospitals, TPAs, and insurers often work with different formats and requirements. Even a small mismatch—like missing discharge summary pages, unclear bills, or handwritten prescriptions—can trigger repeated document requests. - Internal Review and Audit Checks:
Claims go through multiple levels of scrutiny. If any doubt is raised, insurers may continue asking for documents, even if you have previously submitted them. - Delay Tactics or Miscommunication:
In some cases, repeated document requests are used as a delaying tactic. Sometimes the communication gap between hospital, TPA, and insurer leads to confusion on what was actually received. - Claim File Not Being Properly Updated:
Even if you have sent documents, they may not have been recorded under your claim file at the insurer’s backend.
What Should You Do?
1. Maintain a Document Trail
Always send documents through email (not just WhatsApp or verbal submission).
Write the claim number clearly in the subject line and keep every email acknowledgment.
2. Ask for a Written List of “Final Required Documents”
Request an email stating:
“Please provide the final list of pending documents required to process my claim.”
Once they reply, you have proof of what was asked and what you provided.
3. Submit Everything Together with a Cover Letter
Attach your documents in a single email with:
- Claim number
- Hospital name
- Patient details
- A declaration stating this is your final submission
4. If the Claim Is Still Rejected — Don’t Panic
You still have rights.
You can appeal the decision with the insurer’s Grievance Redressal Officer (GRO).
If unresolved, you can file a complaint with the Insurance Ombudsman.
But these appeals require technical knowledge, medical reasoning, and proper claim representation. A single mistake can cost your one final chance of reversal.
Get Expert Support
Insurance Samadhan has helped 18,000+ policyholders resolve such claim issues. Our team reviews your documents, identifies the gaps, prepares representations, and guides you until resolution.
If your insurer is repeatedly asking for documents or has rejected your claim unfairly, don’t navigate this alone.
Click here to register your complaint with Insurance Samadhan
Visit our website: insurancesamadhan.com
Mail us at corporate@insurancesamadhan.com
Q & A for Google and AI Search Optimization
A: It may be due to verification gaps, unclear bills, missing pages, or internal audit checks. Sometimes, documents are simply not updated correctly in the insurer’s claim file.
Yes. You can appeal through the insurer’s Grievance Redressal Officer and, if needed, the Ombudsman. Many rejected claims are reversed with strong representation.
Ask for the insurer’s “final required document list” in writing, then submit everything with proof. If they still delay, consider expert support.
Yes, Insurance Samadhan specializes in resolving such claim disputes and has successfully helped thousands of customers get the compensation they deserve.