Health insurance claim got rejected? Here's what you need to do now
health insurance policies with the hope they never have to use it but with the confidence the policy will come to their rescue in case of an eventuality. However, their moment of truth comes when they seek the policy’s support.
Many people’s claims get rejected though they have been regularly paying the premium.
Such a rejection can come as an unimaginable shock to policyholders, especially if they were heavily depending on this cover to bail them out. If you face such a situation, you must know your options to get the claim amount that rightfully belongs to you.
What to do after your health insurance claim gets rejected?
First, study the reason for the rejection and the course of action recommended in the policy.
“The policy itself will give the protocol for raising a claim and taking it forward in the event of rejection. Most insurance companies have established procedures in this context,” says Sanjay Sen, senior advocate, Supreme Court of India.
You can approach the grievance redressal officers (GRO) of the concerned health insurance company.
Policyholders can approach the ombudsman concerned in case of a rejection, but only after approaching the insurance company first.
“If an insurance claim is rejected by an insurer or if the claim amount awarded is lower than the expense being sought to be covered under the policy, the aggrieved policyholder is required to first file a complaint with the insurer concerned before approaching an ombudsman. Thereafter, the complainant can approach an ombudsman or a consumer court, but not both simultaneously,” says Shoubhik Dasgupta, Partner, Pioneer Legal.
Is it necessary to file an appeal again with the health insurance company after rejection of the claim? Manmeet Kaur, Principal
