How to avoid a health insurance claim rejection?

If policyholders follow rules and abide by the insurance contract, even if the insurance company falters, there are ample regulations in place to protect their rights.

Nov 26, 2015 11:11 IST India Infoline News Service

The most critical time in the tenure of a health insurance policy is when a person files for a claim. It always remains a matter of concern whether the insurer will honor the insurance claim. As per IRDA reports, the number of health insurance claims rejected by insurers for 2009-10 was 14,693. The figures would certainly make any health insurance policyholder skeptical about insurance cover.
 
The scenario
 
If an insurer firm seeks a lower claim ratio, it needs to focus more on insurance policy sourcing compared to the claim reimbursement. At the same, it is vital for the policyholders to follow all procedures and policies mentioned in the insurance document  to ensure the insurance company does not have a reason to reject their claim. 
 
An insurance company intends to make the claim process hassle-free and simple for policyholder. However, since health insurance policies are based on the concept of utmost good faith, it is vital that the policyholder is honest in declarations and follows the policy agreement.
 
If policyholders follow rules and abide by the insurance contract, even if the insurance company falters, there are ample regulations in place to protect their rights.
 
Follow the simple rules
 
Read the insurance policy contract terms and conditions carefully and know them well. In case of any doubt, don’t hesitate to ask questions from the insurer or the advisor. Every insurance firm gives a free-look period of fifteen days to alter or cancel the insurance contract if policyholder finds the contract different from what was conveyed to them.
 
Coverage is based on the information provided by the policyholder in the proposal form and therefore any disparity between what was declared and the facts at the time of filing insurance claims can lead to rejection. It is vital for policyholders to understand that insurance policy is led by underwriting principles based on information given by them. 
 
In order to avoid such a problem, customers should fill up the form themselves. They should provide genuine documents while buying an insurance policy and submit in a timely and orderly manner with all the necessary details.


 
After getting the policy document, read it thoroughly and cross-check all details. In case of any discrepancy, contact the insurance advisor and get it rectified immediately.

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