Imagine you bought a health insurance and later you come to know that all your money, time and investment went to drain because when you needed money, you claim got rejected. How disheartened you will be? We are sure; you never want something like this to happen. So, what to do in order to make your investment a success? You need to learn the correct claim filing process and the mistakes that you should avoid at all cost to save yourself from a potential rejection. Thus, in this article we will focus on these aspects and will make sure to get our dues.
Correct Procedure of Claim
Different Health Insurance companies have different claim process though the basic structure is almost the same. Nowadays, people prefer to choose those companies that can settle their problem quickly instead of dragging it for months. So, below are steps that one should follow to claim their sum assured amount-
- The foremost thing that insurer should do is to inform his/her insurance company that he/she needs to make a claim for his/her health policy because, one cannot afford to waste time in such matters. For instance, a person having individual health policy and one day he/she met with an accident. To take care of the hospitalization expenses, the person needs to inform the insurer at the earliest for filing a claim and get the due amount.
- After informing, it is time to take the health policy claim form either from the office of insurance company, the website if available or the agent and fill the form. However, before filling up the form read the instructions carefully. You don't want to make any mistake that gets your claim rejected.
The details to be filled-
Common Reasons for Rejection of Health Claim
It is quite common to not get the claim amount every time that you apply for the same. However, these instances are lesser than those in which the claim gets accepted. In fact the graphical data below (source-IRDA 2013-2014 annual report) will put more light on several insurance companies and their claim ratio success. In short, it tells you that how many claims were settled and how many got rejected.
Not Claimed on Time– Time is a very important aspect if you want successful settlement of your claim. If you are even few hours late to claim your health policy, you might never get the insured amount at time of need. Suppose, you met with an accident and informed your insurance company a week later, then in that case the company will not entertain your claim request.
Incomplete form– When you fill the health claim form, be sure that you have given full information without hiding anything. If something is missing, then insurance company can easily reject your claim. For example- not filling your contact address or reason for claim.
False claim- If your claim is illegal or false, then not only your claim will be rejected; you might even face the wrath of the company.
Not specific– If, while filling the form, you are not specific enough or you have given a wrong policy code and number, then there are high chances of claim being rejected.
Reason not mentioned– If the reason you require to file a claim is not mentioned in the policy or is out of context, then your claim stands a chance to get rejected.
Thus, in order to get a successful settlement of your claim, you have to be precise and upfront about the incident for which you are making the claim. Needless to mention, you need to follow the time frame specified in your policy documents for filing of claim, failing which, your claim stands no chance to get approved.
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