What are the most common reasons for Health Claims Rejection: The Series

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Today, we are starting with a new series of blogs to educate you on the most common health claim rejection reasons. This series will help you understand the most common health claim rejection scenarios and the important things that are associated with it. It will explore reasons for health claim rejections, providing simple explanations, practical guidance, and much more. It is a feeling of pride for us to provide insights to our readers whom we don’t want to fall into the injustice trap. 

Part 1

Delay in claim intimation or delay in submission of documents

Have you ever wondered why your health insurance claim gets rejected? Health claim rejections occur when your insurance company refuses to approve or pay for a medical claim. These rejections can be frustrating and confusing. Today, we will discuss one of the reasons for the rejections: the delay in intimating about the claim and/or delay in submitting the claim documents. 

Delays can be due to various reasons like non-awareness about the rules or policy, stress during emergency medical treatments, and other unforeseen circumstances. No matter how unavoidable your reason for delay might be, such delay can lead to claim rejection. 

Let us discuss all the what’s, why’s, and hows related to it. First, we have a real-life scenario for you so you understand the situation better.

Insurance Samadhan

Case Study

Ambika Patel faced a claim rejection of her hospitalization claim due to a delay in document submission. Despite being admitted to the hospital for severe health issues, Ambika notified the insurance company after discharge. Citing correct IRDA guidelines, her matter was represented to the company’s grievance team. Ambika urged the authorities to consider her genuine claim, stating that the delay was unavoidable and should not be the sole reason for denial. 

The fact that Ambika got back her claim with the help of Insurance Samadhan does not mean that the policyholder must delay things intentionally. No! Only the cases in which delay is  “due to unavoidable circumstances” can be defended.

Claim rejection

Importance of Timely Claim Intimation and Document Submission

Promptly Filing your health insurance claim is crucial to securing the coverage you deserve, so there is no scope for claim rejection, which must be the first thing in mind. Here are the advantages of timely claim submission:

  • Smooth claim processing: By adhering to the submission timeline, you can avoid unnecessary hassles, inquiries, or complications during the claim process.
  • Better Chance of Approval: Filing a claim on time improves your chances of getting your claim approved. Insurance companies require claims to be filed within a specific time frame.
  • Peace of Mind: Timely claim submission provides peace of mind, knowing that you have taken the necessary steps to protect yourself and your assets.

How Insurance Samadhan Can Help You

If you find yourself in a situation where your claim has been rejected due to a delay in intimation or document submission, despite having genuine reasons, Insurance Samadhan is here to help. 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 cases. We are always here to help you!

Stay tuned For More

Stay connected with our blog series as we will continue to provide valuable insights and real-life scenarios to help you navigate the in and outs of health insurance claims. Insurance Samadhan is committed to empowering policyholders like you and ensuring you receive the coverage you deserve. Together, we can overcome claim rejection challenges and secure your insurance benefits.

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Also Read:  What are the most common reasons for Health Claims Rejection: The Series: Part 7

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Mail us at corporate@insurancesamadhan.com

Shikhar Vashisht

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