Rejected for missing papers or late intimation?
Claims are often closed with a short note: documents not received, or the claim was intimated late. IRDAI’s rules say this alone is not a valid reason to reject or close a claim.
The rule
IRDAI’s Master Circular on Protection of Policyholders’ Interests (2024) says: “No claim shall be rejected or closed for want of documents or for delayed intimation of claim.”
The health insurance master circular adds that once a claim is intimated, the insurer or TPA has to collect the documents it needs from the hospital, and the policyholder shall not be required to submit them.
What the insurer can still ask for
- Your policy document has to list the documents a claimant must submit, and the claims procedure and timelines.
- An insurer can still ask reasonable questions about the claim. Answer them in writing and keep a copy.
- What it can’t do is reject or close the claim only because a paper was missing or you told it late.
What to do
- Ask the insurer or TPA in writing exactly which documents are missing.
- Send what you have, and point out that the insurer or TPA must collect hospital documents itself.
- Write to the Grievance Redressal Officer asking for the claim to be reopened and decided on its merits, quoting the rule above.
- If it stays closed, complain to the Insurance Ombudsman. A rejection that doesn’t follow IRDAI’s rules is a ground for a complaint.
Questions people ask
Can my claim be rejected because I informed the insurer late?
Not for that reason alone. IRDAI’s policyholder-protection master circular says no claim shall be rejected or closed for delayed intimation.
Do I have to collect documents from the hospital?
Under IRDAI’s health master circular, once the claim is intimated the insurer or TPA collects the required documents from the hospital.