Insurance claim rejected? Here's what to do now.

Date : 19/05/2022
Read: 4 mins

Is your insurance claim rejected? Read ahead to know your rights and the options you can pursue to get your claim amount.

Know your rights if your insurance claim has been rejected

In today’s world, where the uncertainty in the lifestyle is changing gradually, there is a risk in almost everything. For example, you never know what hits you on the road or when your car will face an accident, or a sudden heart attack will occur out of nowhere. To get protected against these uncertain situations, a person opts for insurance, be it for a car or health or accidental insurance.

However, many of us miss reading the terms and conditions mentioned in the policy document in a hurry to get insured and end up with a rejected claim. In this article, we are going to focus more on the rights of policyholders against any insurance.

What is an Insurance Claim?

An insurance claim is a request to your insurance company for the payment against losses covered under your insurance policy. The losses can be accidental, health & medical, car, bike, etc., depending on the insurance policy. Insurance is a legal agreement between you and the insurance company to settle losses.

Who can claim insurance?

Insurance claims can be made by the policyholder itself, nominee or legal heir. The relationship with the policyholder could be a guardian, siblings, spouse, or legal nominee.

Why did your insurance claim get rejected?

The denial of claim can be due to several reasons, but it all boils down to the fine print of the insurance policy. Just read the policy carefully, and you will get to know the possible reasons for the rejection.

Terms and Conditions - It is possible that your insurance agent was not able to explain all the intricacies in detail. The supporting documents need to be understood when you purchase an insurance policy.

When the policyholder intentionally misplaces or provides false information for getting the insurance passed by the insurer, the claim for insurance will be denied.
In case the policyholder is negligent when the policy is finalised, he/she may suffer denial of claim. For example, if you signed without reading the documents, then you do not understand the details of the policy.

What are the options you have, and what should you do?

You need to check if you have made any mistakes while filling out the claim settlement form. If yes, refile the claim with correct information and supporting documents. You must try to provide all supporting documents to the insurer, and in case you need an opinion, seek help from an insurance agent who can help you with the filing and explain to you the next steps.

Generally, there is a timeline up to which the claim can be applied. For example, in the case of an accident, the insurance company might allow one week after the accident. So, you need to ensure that you read the fine print and apply the claim within the deadline.

In some medical insurance claims, there is a possibility that the insurance company does not allow some surgical procedures like cosmetic surgeries (liposuction or botox.) Also, most insurance companies do not allow dental treatments. In such a case, you might face denial of claim.

Legal options

You can legally approach IRDA, the Insurance Regulatory and Development Authority.
You can legally approach to Insurance Ombudsmen under Rule 12 of Redress of Public Grievances, 1998
You can legally approach Alternative Dispute Resolution (ADR) under any specific policy.
You can approach the consumer forum court of law.

Conclusion

Insurance documents are complex, and you need to read and understand the documents before signing. There are several legal options, as discussed above. You may take the legal options if you believe that your case is genuine.

Disclaimer: This article is intended for general information purposes only and should not be construed as insurance or investment or tax or legal advice. You should separately obtain independent advice when making decisions in these areas.