Lay Claim On Your Rights

Health insurance claims may often be rejected on legitimate grounds, such as the customer hiding key details on medical history or existing ailments, but there are cases in which claims have been denied even when policyholders are not at fault. Though the road is long-winding, there are redressal mechanisms in place to protect the policyholders. In short, there’s nowhere to hide that Pinocchio nose either for the policyholders or insurers when it comes to claim settlement

- Meghna Maiti and Anuradha Mishra

There is a buzz around rejection of health insurance claims. The Insurance Regulatory and Development Authority of India (Irdai) has come out with a flurry of announcements and proposals aimed at reducing customer complaints. At the same time, the percentage of such complaints has seen a sharp increase after Covid, from 0.80 per cent of total complaints in 2020-21 to above 18 per cent in 2022-23.

No wonder complaints of rejection of health insurance claims abound—a simple search on the social media will throw up numerous such cases.

The problem is that such cases have the potential to wreak financial havoc in the lives of people who may need to undergo expensive treatment for certain illnesses, and also erode the newly-earned trust in health insurance after Covid-19.

Data backs anecdotal experiences. A survey by LocalCircles released in May 2024, a community social media platform, says that 43 per cent of health insurance policyholders surveyed struggled with getting their health insurance claims processed in the last three years. It surveyed 39,000 respondents from across 302 districts of India and was conducted to understand how people buy general insurance, the kind of policies they buy, and where they face the most issues.

According to the Irdai annual report 2022-23, a total of 45,082 health insurance claims were reported during the year, out of which 8,158 or above 18 per cent were repudiated or rejected.