Health insurance is meant to support you during difficult times — but it becomes stressful when your claim gets rejected. Many people think rejection means the end of the process, but in most cases, you can still fix the issue and get your claim approved if you follow the right steps.
In this blog, we’ll explain why claims get rejected and exactly what you should do next, step by step.
✅ Common Reasons Why Health Insurance Claims Get Rejected
Before taking action, you must understand the reason for rejection. Most claim rejections happen due to simple mistakes like:
1) Missing Documents
If any required document is missing, the insurer may reject the claim.
2) Late Intimation
Many policies require you to inform the company within a particular time (especially in reimbursement claims).
3) Pre-Existing Disease Not Disclosed
If you didn’t mention an existing disease at the time of buying the policy, the insurer may deny the claim.
4) Waiting Period Not Completed
Certain treatments have a waiting period (example: hernia, cataract, knee replacement).
5) Treatment Not Covered
Some policies do not cover specific treatments, cosmetic procedures, or OPD expenses.
6) Policy Lapsed or Premium Not Paid
If your policy is inactive, the claim will not be processed.
✅ Step-by-Step: What to Do After Claim Rejection
Step 1: Get the Rejection Letter in Writing
Never accept a verbal rejection. Request the insurer/TPA to provide the rejection reason clearly in writing.
Important: Ask for the exact clause or section of the policy.
Step 2: Verify the Rejection Reason
Now check your policy document and verify if the rejection is valid. Sometimes claims get rejected due to wrong assumptions.
✅ Check these:
Policy start date and waiting period
Coverage inclusions/exclusions
Claim submission dates
Hospital and doctor’s reports
Step 3: Collect and Organize Supporting Documents
Most rejections are solved by submitting the correct documents.
📌 Documents usually needed:
Discharge summary
Final hospital bill
Doctor prescription + diagnostic reports
Claim form signed by hospital/doctor
KYC (Aadhar/PAN)
Cancelled cheque / bank details
Policy copy
Tip: Make one PDF file with all documents in proper order.
Step 4: Apply for Reconsideration / Reprocessing
You can request the insurance company to reprocess/reconsider the claim.
Send an email with:
✅ Claim number
✅ Policy number
✅ Rejection letter copy
✅ Correct documents
✅ Explanation in 5–6 lines
Step 5: Escalate to Insurance Company Grievance Cell
If they don’t respond or reject again, escalate it to the company grievance department.
Every insurer has:
Customer grievance email
Complaint reference number
Timeline for response (usually 7–15 working days)
Step 6: File Complaint in IRDAI (If Needed)
If the insurer still doesn’t solve, you can complain to IRDAI (Insurance Regulatory and Development Authority of India).
IRDAI protects policyholders and ensures fair processing.
You can file through:
IRDAI IGMS portal
Email escalation
Ombudsman (for bigger disputes)
✅ Smart Tips to Avoid Claim Rejection in Future
✔ Always disclose pre-existing diseases honestly
✔ Choose cashless hospital from the insurer list
✔ Submit documents within time
✔ Keep a medical file with previous reports
✔ Maintain policy without lapse
✔ Consult a claim support expert if needed
✅ Final Words
Claim rejection is frustrating — but it is not final in most cases. If you act quickly, gather correct documents, and escalate properly, your claim can still be approved.
If you need help in claim support, document filing, or escalation, we can assist you end-to-end.
Need Claim Support?
📞 Call Us: [Your Number]
💬 WhatsApp: [Your WhatsApp Link]
📧 Email: [Your Email]