Understand Claim Rejection

Figuring out why your claim has been denied?

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.

Claim Rejection

Possible reasons for claim denial by insurer

Waiting Period

30 days waiting period

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.

2 years waiting period

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 of insurance policy.

Waiting Period
Exclusion in Health Policy

In case of Permanent exclusions

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 ClaimTherapist experts.

24-hour hospitalization compulsory in Medical Management

As per the rule, it is compulsory for a patient to be admitted for at least 24 hours in the hospital to apply for a health insurance claim. Any claim processed under this condition will be denied.

Emergency Admission
Sum insured

Sum insured exhausted

In case the sum insured has exhausted, it will lead to claim denial. The ideal solution is to recharge the exhausted sum insured.

Missing document

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.

Missing Documents
Medical bills

Error in paperwork or wrong medical bills

A silly print error or wrong medical bills by a chemist can lead to a risk of claim denial. Bring your bills and documents to get them verified by ClaimTherapist experts.

When health insurance claim gets rejected, learn the
next step with an expert!

Why did your health insurance claim get rejected?

There can be several reasons behind claim denial like your treatment is not covered under your policy or sum insured has exhausted. Claims can also be denied because of your pre-existing medical history. Learn more with ClaimTherapist now.

Is there any possibility to reclaim your health insurance after rejection?

Claim rejection by insurance companies is not the end of the road. Even an insurer/TPA can make a mistake while processing insurance claims. If you feel the claim rejection is not valid, you can dispute and request them to reconsider it with justification and medical facts. Take help from us.

Health insurance claim got denied. How to dispute?

If your claim has been 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 the Grievance of the insurance company. If the dispute is not working out, you can further complain to the Ombudsman. Talk to an expert if you need more suggestions.