Frequently asked questions

1. Incomplete Documentation

One of the most common reasons claims are rejected is missing or incorrect paperwork. Many policyholders submit hospital bills but forget key supporting documents like the discharge summary, investigation reports, or prescription copies.

How to fix it:

Carefully check the insurer’s documentation checklist. At Claim Wise, we help clients prepare a comprehensive file with all required documents—so nothing gets missed.

2. Pre-Existing Illness Not Disclosed

If you didn’t mention a pre-existing condition when buying the policy, the insurer may reject your claim citing non-disclosure or misrepresentation.

What you can do:

If it was an honest mistake or lack of awareness, you can appeal. Our legal experts help build a case to show no intentional misrepresentation was made.

3. Waiting Period Not Completed

Most policies have a waiting period (usually 2–4 years) for certain illnesses like diabetes, hernia, or maternity benefits. If treatment happens within this period, your claim may be denied.

Pro Tip:

Always check the policy fine print. We help clients identify and challenge wrongful rejection if the treatment was unrelated or if the policy terms were misapplied.

4. Treatment Not Covered by Policy

Claims are often rejected because the policy doesn’t cover specific treatments like cosmetic surgery, infertility, or experimental therapy.

Solution:

We review your policy terms and hospital records to check if the insurer made a legitimate decision—or rejected a valid claim under a wrong interpretation.

5. Delay in Claim Submission

Insurers require that you inform them within 24–48 hours of hospitalization. Delay in intimation or filing the claim after the deadline can lead to rejection.

Our Role:

If your delay was justified (like emergency hospitalization), we prepare a strong justification and file a re-appeal on your behalf.

Top 5 Reasons Why Health Insurance Claims Get Rejected in India