Rejected for “less than 24 hours in hospital”?

What most policies say

IRDAI’s 2020 standard definitions were repealed in 2024 as regulation, but most policy wordings still use them word for word. So the definitions in your own policy decide the claim. Typically:

• Hospitalisation means at least 24 consecutive hours as an in-patient, except for specified procedures or treatments.
• Day care treatment is a procedure done under general or local anaesthesia in less than 24 hours because of advances in technology, which would otherwise have needed more than 24 hours in hospital.
• Normal OPD treatment is not day care.
• Insurers can limit day-care cover to a listed set of procedures, so check the list in your policy.

When the rejection is weak

• The procedure is day care under your policy’s definition or on its day-care list, such as cataract surgery, chemotherapy or dialysis in many policies.
• The policy’s hospitalisation definition has an exception for specified procedures, and yours is one of them.
• The rejection letter doesn’t name the clause it relies on. A rejection must cite the specific policy terms.

When the insurer is likely right

• The treatment was ordinary OPD care, such as a consultation or tests, without a procedure.
• Your policy limits day care to a list, and the procedure is not on it.

What to do

1. Find the definitions of hospitalisation and day care, and the day-care list, in your policy wording.
2. Ask the hospital for a note on the procedure and the anaesthesia used, if the discharge summary doesn’t say.
3. Write to the Grievance Redressal Officer quoting the policy’s own definition, then go to the Insurance Ombudsman if needed.