Ashok Joshi, 45, was admitted to the hospital recently for a cardiovascular emergency. He ran up a bill of Rs 3 lakh. He was not worried about the cost since he had a health insurance cover of Rs 5 lakh. However, when he applied for his insurance claim, the insurance company rejected it. This was because he had failed to inform his insurance provider that he was a smoker.
This is just one instance of how a genuine insurance claim may be rejected due to lapse on part of the policyholder. There could be several such instances, where your insurance claim, be it life, health, motor or travel, may be rejected due to reasons within your control. Let us what some of these could be. Let us also understand what steps you should follow at different stages of your policy.
While buying the insurance policy:
There are certain aspects to keep in mind before you buy an insurance policy. If you fail to do so, your claim may get rejected. Here’s what you should keep in mind while buying the policy
- Disclose all information; do not hide pre-existing diseases: If you are a smoker, like Ashok, you should disclose this information when applying for the insurance. Similarly, if you have pre-existing diseases, such as diabetes, high blood pressure, cardiac problems, etc, you should declare those as well. These conditions impact the calculation of your premium. If you hide these conditions from your insurer, your claim could be rejected based on non-disclosure of previous conditions.
- Provide accurate and up-to-date details about yourself/ nominee: If you want a specific person/s to avail benefits from your life insurance policy, please ensure that your nomination is correct and up-to-date. Generally, nominees are the ones who are dependent on you. If you miss filling these details in the insurance application form, then your nominees may not get the amount or they may have to follow a cumbersome process to get the claims. Similarly, misspelt names and wrong addresses are also reasons why your claim may get rejected. Hence, pay attention to these details when filling the application form.
During the policy term:
Once you buy the policy you need to pay premiums on time, undergo check-ups as mentioned in the policy conditions, update personal details, inform the insurer about changes in your health status, etc. If not, you may find yourself getting stuck during the claim process.
- Pay premium on time: In the case of term life, health or motor insurance, if you don’t pay your premiums, the whole policy stands lapsed. If you think that you will be able to get a certain sum for the number of premiums paid, it is not so. If you miss your premium, your coverage ends, no matter how many years you had renewed it. Insurance providers will not entertain any claims on lapsed policies.
- Don’t miss your medical check-up: If your insurance provider wants you to come in for medical exams regularly, you should not miss a single date. If you forget your date, the company has a reason to deny your claim.
While making the claim
Following the right claim procedure is critical and essential to ensure that you get your rightful dues without a hassle. Ensure that you meet following conditions during the claim process:
- File the claim on time: The longer you wait to file your claim, higher the chances of your insurer rejecting it. In case of death, you have to reach out to the insurer immediately and intimate them about the deceased so that the process of claiming insurance can start. In the case of health insurance, you have to inform your health insurer within 24-48 hours of being hospitalized. If you don’t, your claim may be rejected. In case of motor insurance too, you must inform your insurer immediately in case of theft of your vehicle or damage due to accident or natural calamity. In case of travel insurance, make the claim application as soon as you return from your trip.
- Claim only what is covered in your policy: Understand the exclusions in your health insurance plan. Intentional injuries, congenital conditions, pregnancy-related costs, cosmetic surgery (unless in case of an accident) and alternative kinds of medicine (homoeopathy, Ayurveda, etc.) are standard exclusions in many health insurance plans. Sometimes, lifestyle diseases are not covered under regular health insurance. You might have to pay a higher premium for the same. If not, these claims may be rejected.
- Documentation should be complete: Particularly in case of health insurance make sure you submit all the bills with details such as doctors’ reports, test reports, medicines prescribed, post-operative check-ups or treatments recommended, etc, to avoid any confusion. Or you may end up wasting time following up with your insurance to get your claims approved.This holds good for motor insurance claims too, where you are getting the repairs done yourself. Make sure you submit the repair bills and receipts to the insurance company or surveyor to get the amount reimbursed.
For travel insurance, you will need to submit receipts of items that have been lost or damaged, while travelling or hospital bills if you have spent money for a medical emergency during your travel. You would also need a letter from the airline confirming the loss of luggage or delay. Other documents that you would need to present to the insurer include copies of the tickets, boarding pass and baggage tags.
- Don’t claim beyond the allowed limit: Health insurance policies have limits on daily expenses. For example, if your health insurance covers expenses up to Rs 3,000 a day, and your everyday expenses are Rs 4,000, you have to pay that Rs 1,000 from your pocket daily. You have to fill the claim keeping this in mind. If not, it could again lead to your claim getting rejected or delay in the claim approval.
- File a police complaint, or provide photographs of the accident: For motor insurance claims, drivers’ license and copies of the insurance policy are a must while submitting the claim application. If your vehicle is damaged due to accident or natural calamities, attach photographs of the vehicle with your claim application. Today, many insurance companies allow photographs to be submitted through their apps. Make use of this feature to ensure seamless claim application.Similarly, if your vehicle has been involved in an accident and there is damage to property or injury to a person, lodge a police complaint and attach copies of the First Information Report. It is helpful to also provide contact details of all other passengers who were with you at the time of the accident. If possible, also provide details of any witnesses present during the accident. This will make it easier for the insurance company’s surveyor to write the report about your claim and in turn, help faster processing of your claim.
In case of theft too, police complaint is a must, copies of which should be submitted with your claim application.
Insurance is meant to provide you with a safety net in times of emergency. Since emergencies crop up unexpectedly, it always helps to remain prepared. Axis Bank has tie-ups with multiple health insurance companies including Aditya Birla, Digit, Tata AIG and HDFC Ergo. Click here to choose the plan that best meets your and your family’s requirements.
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