Claim Process Mistakes That Lead to Rejection

Many policyholders face claim rejection due to health insurance claim process mistakes, even when the treatment itself is valid and covered under the policy.

Missed the beginning?
Read Part 1: Why Health Insurance Claims Get Rejected in India before continuing.

4. Delay in Informing the Insurance Company

Insurance companies require timely intimation:

• • For planned hospitalisation, pre-authorization is mandatory.

• • For emergency admissions, insurers usually need to be informed within 24 to 48 hours.

Late intimation or no intimation can result in claim rejection or delays.

5. Missing or Incorrect Documents

Incomplete or incorrect paperwork is one of the biggest reasons claims get stuck or denied. Commonly required documents include:

• • Discharge summary

• • Detailed hospital bills

• • Doctor’s prescriptions

• • Diagnostic reports

• • Policy copy and ID proof

If documents are missing, unclear, or inconsistent, insurers may reject or delay the claim.

6. No Pre-Approval for Planned Hospitalisation

For planned treatments, advance approval from the insurer is required for cashless claims.

If hospitalisation is done without pre-authorization, the insurer may deny cashless treatment and may also reject reimbursement, depending on policy terms.

Continue reading in Part 1, Why Health Insurance Claims Get Rejected in India

And Part 3, Coverage Limitations, Hospital Issues & How We Help