Covered, Yet Battered

Rejection of insurance claims is a regular affair in the field of medical insurance, health insurance and motor insurance. Rejection by the insurer is not the end of the world. You have the right to fight for your claim

- Nirmala Konjengbam

When Noida resident Rakesh Jaiswal had to be admitted to a private hospital for a sudden heart issue, he was under the impression that his cashless medical insurance policy would take care of the finances. But, it didn’t work the way he thought. The third-party administrator denied the cashless facility to him and he had to cough up the entire bill himself.

Once out of the hospital, Jaiswal contested the rejection of his claim with the insurer only to be informed that he was not eligible for the facility. Undeterred, he moved the mandated government forum for grievance redressal, and was awarded a compensation fee later.

A large number of insurance claims – life, health or motor – get rejected by insurance companies every year. While in some cases, there are negligence on the part of the insurers, most cases are dropped because of false information, incorrect medical history disclosure, or non-payment of premiums.

If you ever experience a situation where your claim is denied by an insurance company, it’s within your right to appeal against the rejection. Apart from asking the insurer to review the claim rejection, policyholders or nominees could also approach government authorities for grievance redressal.

“Insurers would normally settle all claims other than cases of material non-disclosure by customers. Rejecting or repudiating such claims is a fair practice keeping in mind the interests of all other policyholders. Usually there are elaborate procedures within the insurance company before rejecting or repudiating claims, including investigation and legal checks,” says G Murlidhar, Managing Director at Kotak Mahindra Life Insurance.