There are several reasons insurance companies deny claims for. While some reasons might be valid and can’t be avoided, few reasons can be disputed. Make sure you don’t get overwhelmed or emotionally driven by a claim rejection and take the right step by consulting with an expert like ClaimTherapist.
There is an initial waiting period of 30-90 days after the policy is purchased. Any claims made during this period are denied, however, there are some exceptions too. Know more from our experts to get assistance.
There is a specific list of diseases for which the waiting period is around 2 to 4 years such as Hernia, Fissure, Schizophrenia etc. Therefore, if your disease has a waiting period clause, your claim will be denied. Learn more about your policy from our experts and get the maximum benefits.
Every policy has some permanent exclusion in it. So, in case the claim processed is for a disease that is permanently excluded, the claim will automatically be denied. Know your policy better, consult ClaimTherpaist experts.
As per the rule, it is compulsory for a patient to be admitted for at least 24 hours in the hospital to claim the policy. Any claim processed under this condition will be denied.
In case the sum insured has exhausted, the policy will be denied. The ideal solution is to recharge the exhausted sum insured.
During an emergency, you may miss submitting a document. To avoid uncertain claim rejection or insurer's query, consult with an expert before you file a claim.
A silly print error or wrong medical bills by chemist can lead to a risk of claim denial. Bring your bills and documents to get them verified by ClaimTherapist experts.
There can be various reasons behind claim denial (e.g. the treatment is not covered under your policy, your sum insured got exhausted etc.). Claim can also get rejected because of your pre-existing medical history. Learn more with ClaimTheapist now.
Claim rejection by insurance is not the end of the road. Even insurer/TPA can make a mistake while processing the claim. If you feel claim rejection is not valid, you can dispute and request them to reconsider the claim with your justification and medical facts. Ask us to learn more.
If a claim is denied, the first thing you need to do is to request your insurer/TPA to reconsider the claim. If you are not satisfied with the outcome, you need to lodge a complaint with Grievance of the insurance company. If the dispute is not working out, you can further complaint to Ombudsman. Talk to an expert if you need more suggestions.