What insurers don’t tell you — and how to avoid costly mistakes.
Many insurance claims in India get rejected due to avoidable mistakes, missing documents,
or policy misunderstandings. Knowing these reasons in advance helps ensure a smooth and successful claim process.
1. Non-Disclosure of Medical History
One of the most common reasons for claim rejection is hiding or not declaring medical history such as:
- Diabetes, BP, thyroid issues
- Past surgeries or treatments
- Smoking or alcohol habits
Why it gets rejected: Insurers treat this as misrepresentation.
How to avoid: Always disclose your health conditions honestly at the time of buying the policy.
2. Policy Lapsed Due to Missed Payments
If your policy premium is not paid on time, the policy lapses, and any claim during this period will be rejected.
How to avoid: Enable auto-debit or set a reminder for premium due dates.
3. Claim for an Excluded Illness or Treatment
Every health or life insurance policy has exclusions. Common exclusions include:
- Cosmetic or beauty procedures
- Dental treatments (non-accidental)
- Fertility or infertility treatments
- Certain illnesses during the waiting period
How to avoid: Read the exclusions section in your policy document carefully.
4. Waiting Period Not Completed
Health insurance comes with various waiting periods:
- Initial 30-day waiting period
- 1–3 years waiting for specific illnesses
- 2–4 years waiting for pre-existing diseases
If hospitalisation occurs during this period, the claim can be rejected.
5. Cashless Treatment Taken at a Non-Network Hospital
Cashless claims are only valid at network hospitals. Treatment outside the network leads to rejection of cashless requests.
How to avoid: Always check whether the hospital is in your insurer’s network list.
6. Missing or Incorrect Documents
Claims often get denied because essential documents are missing. Insurers usually need:
- Original bills & receipts
- Discharge summary
- Doctor prescriptions
- Diagnostic test reports
- Correctly filled claim form
7. Claim Not Intimated on Time
Insurers require timely intimation about hospitalisation or an emergency.
- Emergency cases: within 24 hours
- Planned hospitalisation: 48–72 hours before
8. Fraudulent or Inflated Claims
If the insurer finds fake bills, inflated charges, or manipulated documents,
the claim can be rejected immediately.
9. Wrong Coverage or Policy Type Purchased
Example: Filing a maternity claim when the policy doesn’t include maternity cover,
or exceeding room rent limits that reduce claim eligibility.
10. Submitting the Claim After Deadline
Claims must be submitted within a specific time (usually 7–30 days after discharge).
Missing the deadline leads to automatic rejection.
11. Hospital Documentation Issues
If the hospital provides unclear or incomplete records such as missing signatures,
wrong diagnosis codes, or incorrect discharge summaries, the insurer may reject the claim.
How to Prevent Claim Rejections
- Read your policy document thoroughly
- Disclose all medical history honestly
- Keep all original bills and reports
- Inform the insurer immediately during admission
- Submit documents within the deadline
- Choose network hospitals whenever possible
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