Health Insurance Claim Rejected? Common Reasons & What to Do (India 2026)
Facing a health insurance claim rejection can be extremely stressful, especially when you are already dealing with a medical emergency. Many policyholders realise the importance of policy terms only after their claim is rejected.
This article is written to help you understand why health insurance claims get rejected in India and what practical steps you can take to avoid or resolve such situations in the future.
What Does Health Insurance Claim Rejection Mean?
A health insurance claim rejection occurs when the insurance company refuses to pay for the medical expenses claimed by the policyholder. This can happen during cashless hospitalisation or reimbursement claims.
Most Common Reasons for Health Insurance Claim Rejection
In many cases, claim rejection is not due to fraud or wrongdoing, but due to lack of awareness about policy conditions. Small details such as waiting periods or documentation timelines often become major problems during claim settlement.
1. Non-Disclosure of Pre-Existing Diseases
One of the most common reasons for claim rejection is failure to disclose pre-existing medical conditions at the time of policy purchase. Even unintentional non-disclosure can lead to rejection.
2. Waiting Period Not Completed
Most health insurance policies have a waiting period for specific diseases and pre-existing conditions. Claims made during this period are usually rejected.
3. Treatment Not Covered Under Policy
Some treatments, cosmetic procedures, and alternative therapies may not be covered. Always check policy inclusions and exclusions.
4. Hospital Not in Network
For cashless claims, treatment must be taken at a network hospital. Non-network hospitalisation can lead to rejection or partial reimbursement.
5. Delay in Claim Intimation
Insurance companies require claim intimation within a specified time. Delays may result in claim rejection.
6. Incorrect or Incomplete Documentation
Missing bills, reports, or incorrect details can cause claim rejection.
Many claim issues can be avoided by choosing the right policy in advance. Learn how to select the best
health insurance for parents in India
to reduce claim rejection risks.
Health Insurance Claim Rejected – What Should You Do?
Step 1: Check the Rejection Reason Carefully
Always read the rejection letter or email carefully to understand the exact reason.
Step 2: Review Your Policy Document
Cross-check the rejection reason with your policy terms and conditions.
Step 3: Contact Customer Support
Reach out to the insurer’s customer care team for clarification.
Step 4: Submit Missing Documents
If rejection is due to incomplete documentation, submit the required documents promptly.
Step 5: File a Grievance
If you believe the rejection is unfair, file a grievance with the insurance company.
Step 6: Approach the Insurance Ombudsman
If the issue is unresolved, you can approach the Insurance Ombudsman for dispute resolution.
How to Avoid Health Insurance Claim Rejection
- Disclose medical history honestly
- Understand waiting periods
- Choose network hospitals
- Keep all medical documents safely
- Inform insurer within required timelines
Cashless vs Reimbursement Claim Rejection
| Type | Cashless Claim | Reimbursement Claim |
|---|---|---|
| Hospital Type | Network hospitals only | Any hospital |
| Documentation | Minimal | Extensive |
| Rejection Risk | Lower | Higher |
Frequently Asked Questions
How long does claim settlement take after resubmission?
It usually takes 7–30 days depending on the insurer.
Is claim rejection common in health insurance?
Yes, but most rejections occur due to policyholder errors.
Can a rejected health insurance claim be approved again?
Yes, in some cases a rejected claim can be reconsidered if the required documents are submitted or if the rejection reason is clarified. It is always advisable to communicate clearly with the insurer before assuming the claim is permanently denied.
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Final Thoughts
Health insurance works best when policy terms are clearly understood in advance. Claim rejection can often be avoided with proper disclosure, timely communication, and correct documentation.
This guide aims to help you stay informed and prepared so that insurance supports you when you need it the most.
Disclaimer: This article is for informational purposes only and does not constitute insurance advice.