What if a Health Insurance Company Says "No" to Your Claim?

by MyMoney Mantra FinTech (Financial Technology)

We all buy health insurance policies, keeping in mind that unforeseen disease outbreak (remember the dengue menace in New Delhi), or that unlucky accident on your bike. For such occasions, buying Health Insurance policy is something everyone advices for, but no one ever tells you what to do if your health insurance company says no to your claim.

Before we dive into the question of what options do you have if your claim is rejected by the insurance company, let’s take a look at some reasons why your claim might get rejected:

Incorrect Information

If you provided wrong information while filling out the policy form or hid something related your health/lifestyle conditions, this might result into rejection of your claim. To avoid such scenarios, we always advise that you always provide genuine and honest information to the insurance company.

Not Reading the Offer Document

This is one of those cases where you have no one to blame but yourself. Insurance advisers try their best to explain the policy terms and conditions but you must always read the agreement properly. Always read the part where it talks about the reasons for policy termination.

Now, let's talk about what you should do if you feel that your claim shouldn’t have been rejected. But, make sure you don't fall in either of the above mentioned categories.

Go Back, Read the Policy Documents

First thing you need to do is read your policy documents and look for anything which might support your argument. Try to note down or highlight the exact wording written in your policy documents that says you are covered under this policy.

Contact the Insurance Company

Once you are sure that your claim has been rejected without any reason, you need to contact the insurance company and express your concerns. The first intimation could be via telephone but you need to document your grievance either through sending a formal complaint email/Fax or courier with a complain letter.

Get External Help

If the insurance company is bombarding you with letters written in technical language and you are finding it too overwhelming to cope with, seek out professional help. They would of course charge a fee for their services but it can be the helping hand you are looking for.

File a Complaint to Ombudsman

The last resort is to file a formal complain to the Ombudsman. Here, both the parties, you and the insurance company, would be allocated a date for your case hearing. You may decide to hire professionals to represent you at the hearing or represent yourself.

Both the insurance regulator (IRDA, in case of India) and the government want to help the policyholders and look out for their interests against big Insurance companies. So, do not hesitate to challenge the Insurance Companies if you find something fishy.

For avoiding such untoward situations, it is better to understand you policy document before buying a Health Insurance. For more information about Health Insurance policies, visit mymoneymantra.com, a leading online lending marketplace. You can also talk to our Health Insurance experts toll-free at 1800 103 4004.