Most people buy insurance thinking the claim will be settled automatically. But in reality, claims get rejected due to small errors—wrong information, missing documents, or delay in reporting.
Here are the top reasons for rejection:
1️⃣ Not disclosing correct information
People often hide medical history, add “perfect health” details, or avoid mentioning smoking habits.
But when hospitalization happens, insurers check your past records. Any mismatch leads to rejection.
2️⃣ Filing claim after the deadline
Every policy has reporting timelines. Delay — even by a few days — gives the insurer a valid reason to deny the claim.
Always inform the insurer within 24–48 hours.
3️⃣ Incorrect or incomplete documents
Hospital bills without seal, unclear prescriptions, or missing discharge summary can stall your claim for weeks.
4️⃣ Policy exclusions
Some policies don't cover:
-
Pre-existing diseases (for a specific waiting period)
-
Cosmetic surgeries
-
Non-allopathic treatments
-
Accidents under influence of alcohol
Knowing exclusions is as important as knowing coverage.
5️⃣ Not reading the fine print
Most disputes happen because customers trust verbal promises but never read the policy terms.
👉 The good news: With proper documentation and timely action, 90% of claim rejections can be avoided.