How to prevent rejection of Medical Insurance claims in India?

In today’s dynamic world, having health insurance is a crucial aspect of our financial planning. It serves as a safety net, ensuring we’re prepared to handle medical expenses during unexpected times. However, experiencing the frustration of a denied insurance claim can be quite unsettling and can pose a financial burden. To avoid finding yourself in such a predicament, it’s essential to grasp the common reasons behind claim rejections and learn how to steer clear of them.

Reasons for Health Insurance Claim Rejection and How to Avoid Them

Facing health insurance claim rejection can be a daunting and financially distressing experience. To help you navigate this challenge, let’s delve into the main reasons behind claim rejections and discover effective strategies to prevent them.

●     Inaccurate Information

One major reason for claim rejection is giving incorrect information when buying medical insurance plans. When completing your application, it’s crucial to be completely honest. If you provide wrong details about your medical history, lifestyle, or any pre-existing health problems, your claim could be turned down if the insurance company discovers it. To prevent this, it’s wise to share correct information and consider having a thorough medical check-up before purchasing the policy.

●     Waiting Period Violation

Many medical insurance plans in India have a waiting time, particularly for pre-existing conditions. If you attempt to file a claim during this waiting period, it’s quite likely it’ll get declined. To avoid this, choose a medical insurance plan that suits your health needs and has shorter waiting times. Or, make sure you keep your coverage going without any breaks, as this might reduce the waiting period.

●     Non-Disclosure of Pre-Existing Conditions

Not telling the insurance company about your existing health problems is a common reason why claims get denied. When you’re getting a medical insurance plan, it’s crucial to share all your current health issues with them. Even if it means shelling out a little extra in premiums, it assures you of excellent coverage. What’s more, some insurance companies offer plans specifically designed for folks with pre-existing conditions.

●     Waiting for Renewal for a New Medical Condition

Some policyholders wait until policy renewal to include a new medical condition in their coverage. Insurance companies might see this as trying to hide the condition on purpose and turning down your claim. To avoid this, tell your insurer right away when you’re diagnosed with a new medical condition and talk about adding it to your policy.

●     Not Following the Policy Terms

Each health insurance plan has distinct criteria and terms that you, as the policyholder, must adhere to. Non-compliance with these specifications increases the likelihood of your claim not receiving approval. It’s essential to thoroughly understand the policy document, including limits on room rent, co-pay, sub-limits, and exclusions. Adhering to these terms will help ensure that your claims are processed smoothly.

●     Delay in Filing Claims

A delay in filing a claim can also lead to its rejection. Insurance companies have a specified duration within which claims must be filed. To avoid this, be prompt in initiating the claim process and ensure you provide all necessary documents and information as per the insurer’s guidelines.


In India, having a mediclaim policy for family is a must to protect your health and money. To make sure your claims aren’t turned down, it’s really important to give the right details, be honest about any existing health problems, and follow the policy rules. Also, don’t wait and file your claims on time. Remember, when you’re selecting your medical insurance plan, being well-informed can truly safeguard your finances.

When you’re thinking about which medical insurance is best for you and your family, Niva Bupa provides a variety of health insurance options that are customised to your requirements. To learn more about their offerings, visit Niva Bupa’s Health Insurance page.

In a world where health uncertainties can strike at any time, having the right medical insurance plan is your best defence. Take proactive steps to safeguard your health and financial well-being with a trusted insurer like Niva Bupa.

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