When Can Your Health Insurance Claim Be Rejected?

If the Coronavirus pandemic has taught us anything, it is that we can never be adequately prepared to handle a crisis that nature throws at us. Currently, as per Worldometer, there are more than 5 million reported cases of COVID-19 across the world.

Apart from taking protective measures to ensure that you are not exposed to the virus, you should also purchase a health insurance policy—it can cover medical expenses in case you or a your loved one require hospitalization.

However, you should not give your insurer any reason to reject your claim. Below is a list of instances wherein your insurance claim may be rejected.

  1. Exceeding your sum insured

Your mediclaim’s sun insured is the maximum amount of money you are eligible to receive from your insurer. However, if the amount is exhausted before the end of the year, you will not be eligible to make a cashless treatment claim again in the same year—it will be rejected by the insurer.

  1. Ignoring the exclusions

All health insurance plans come with certain exclusions, which are diseases or conditions that are not covered by the policy.

When you are purchasing health cover, carefully read the policy document to be fully aware of the exclusions. If you are ever diagnosed with any of the excluded illnesses, your insurance claim will be rejected.

  1. Giving false information

When you make a health insurance claim, the insurer checks all disclosures you had made when buying the policy: your age, pre-existing conditions, income, profession, and other relevant information.

If you had previously lied about any information or provided incomplete information, the insurer may reject your claim. Always provide accurate and complete information on your policy form to prevent this from happening.

  1. Failing to meet the time limit

Most health covers come with a specific time limit, beyond which you cannot claim reimbursements.

For example, in case of emergency hospitalization, you need to file the claim within 24 hours. This may vary depending on the policy or the scenario, but usually claims made beyond the time limit will be rejected. The best way to avoid this is to make your claim as soon as possible.

All of the above mistakes can be avoided if you keep your health policy’s terms and regulations in mind. You can always use a health insurance premium calculator to determine which policy will be the right one for you.

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