ClaimRejectedMy reports

How it works

How ClaimRejected works,
and how we test it.

You should know where an answer comes from before you rely on it. Here is what happens to your claim, where our rules come from, how we check our work, and where its limits are.

What happens to your claim

  1. 1

    We read your papers

    Your documents are turned into text. Photos and scans are fine.

  2. 2

    We pull out the facts, with their words

    Policy dates, the diagnosis, the amounts and the insurer’s reason, each with the exact words it came from. Our code checks every quote against your documents and drops any it can’t find.

  3. 3

    We ask fixed questions about those facts

    A set list of yes/no questions: is there a dated record of the condition, did the proposal form ask about it, does the letter cite a clause, and so on.

  4. 4

    Code applies the rules

    The rules, dates and deadlines are worked out by fixed code from the rulebook, not by an AI writing freely. The same facts always give the same result.

  5. 5

    You see what we found, and what we couldn’t tell

    Each point shows whether it comes from your documents or from your answers. Where something isn’t in the papers, we say so and ask you, rather than guess.

Where the rules come from

Our rulebook is read from the primary documents, not summaries. Each rule carries its source and a note of how sure we are of it. Rules that have been repealed are kept only as history and never applied to a current claim. Policy wordings often still repeat old standard definitions, so where that matters we point you to your own policy.

How we test it

Every version of the checker is tested against hundreds of real decided disputes from consumer commissions, High Courts, the National Commission and the Insurance Ombudsman. For each case we rebuild only the papers the policyholder had before the dispute, run the checker, and compare its call with how the case actually ended.

  • Cases the insurer won and cases the policyholder won are both in the test set
  • Half the cases are locked away and never used for tuning
  • Changes are tuned on one half and scored on the locked half
  • We don’t publish accuracy figures: test cases are reconstructions, and your claim isn’t a test case

Honest limits

A report can only be as complete as the papers you give it. If the proposal form or an old prescription isn’t uploaded, we can’t see it, and we’ll ask rather than assume.

Your policy wording decides many questions, and wordings differ. Forums weigh evidence and people, not just rules, so they sometimes decide differently from what the papers suggest, in either direction.

We cover health and mediclaim claims only. A report is a rule-backed starting point, not legal advice. For a court case, talk to a lawyer.

What we do

  • Quote your own documents for every fact
  • Cite the rule number behind every point
  • Tell you plainly when the insurer’s reason looks valid on your papers
  • Show the next step and every deadline

What we don’t do

  • Work for insurers, brokers or hospitals
  • Take a share of any money you recover
  • Contact the insurer on your behalf
  • Give legal advice or promise an outcome
  • Sell your data or use your documents to train AI models

Your data

Uploaded documents are deleted automatically 90 days after a report. Your report stays in your account until you delete it. The service providers that process your documents are named in our privacy policy.

Spotted a mistake in a rule or a guide? Tell us and we’ll check it against the source and correct it. See a sample report to judge the output for yourself.

We’re on your side
of the claim.

Insurers have claim teams. Now you have the rules, the facts and the next step, in about a minute.

Get my free reportSee a sample report