Claim guide

Your claim was rejected. Here is what to do.

A rejection is a decision, not the end. There is a clear path to fight it, it is free, and most rejections in India happen because of paperwork, not because you were not really ill.

First, ask why in writing

Ask your insurance company which policy line they used to reject your claim. Ask by email, so you have it in writing.

"Not payable" is not a real answer. A real answer names the exact line in your policy. Many rejections change once someone has to write the reason down.

Then go step by step

Do them in this order. Each step will ask what happened in the step before.

1. Your insurance company Call them, use their website, or visit a branch. The numbers are in your policy paper. Give your claim number and ask for the reason in writing.
2. Their grievance team Every company has one, separate from normal customer care. Use their grievance page so you get a complaint number. Keep that number.
3. IRDAI Still not solved? File it free on the Bima Bharosa website: bimabharosa.irdai.gov.in. You can also check the status there.
4. Insurance Ombudsman An independent office that decides insurance fights without going to court. It is free and you do not need a lawyer. Addresses are in your policy paper and at cioins.co.in.

Why claims get rejected

Most of the time it is one of these, and most of them were fixable before you sent the file:

• A paper was missing. Usually the pharmacy bill or the payment receipts.
• Dates did not match between the claim form, the bill and the discharge summary.
• The claim form was not complete. Not signed by you, or not signed and stamped by the hospital.
• A waiting period applied. Some illnesses are covered only after the policy has run some time. This depends on your own policy.
• The room cost more than your policy allows. Then the company can cut part of the other charges too.
• Non-payable items like gloves, admission kit or attendant food. These are always your own cost.