Your health insurance claim was rejected. Here is what to do.
A rejected claim is not always the end of the road. Many rejections are about process or paperwork, not a genuine lack of cover, and those can be fixed. The key is to understand why it was rejected, then respond in the right order.
Why claims get rejected
- Non-disclosure: a pre-existing condition or habit not declared at purchase. The single biggest reason.
- Waiting period: claiming for something still inside its PED or initial waiting window.
- Exclusions: the treatment is a permanent exclusion under the policy.
- Documentation: missing discharge summary, itemised bills, or investigation reports.
- Cashless denial: often a network or eligibility issue, not a final rejection. You can still file reimbursement.
A calm, step-by-step response
- Get the reason in writing. Insurers must state the ground for rejection. Read it against your policy wording.
- Separate "denied" from "needs documents". Many rejections are really requests for missing paperwork you can supply.
- Gather evidence. Discharge summary, all bills, prescriptions, reports, and your policy schedule.
- Raise a grievance with the insurer. Use their grievance channel with a clear, factual note and documents.
- Escalate. If unresolved, the Insurance Ombudsman handles eligible complaints. Keep every communication.
Prevent the next one
Most rejections trace back to purchase-time choices: full disclosure, understanding waiting periods, and knowing your exclusions. Run your policy through our policy checker to surface the clauses that decide claims before you ever file one.