Rejection reasons
What does your letter
actually say?
Find the reason your insurer gave. Each guide explains the rule behind it, when the rejection is weak, and what to do next.
Your medical history
- “Non-disclosure” or “misrepresentation”When an insurer can and can’t reject a health claim for non-disclosure: the proposal form test, the 60-month moratorium and the evidence that matters.
- “Pre-existing disease” or “waiting period not over”What counts as a pre-existing disease, the 36-month waiting period caps, ported cover, the 60-month moratorium and the accident exception.
- Old history raised after years of coverAfter 60 months of continuous cover, an insurer can’t contest your health claim for non-disclosure except for fraud. How the months are counted.
- Waiting period counted only from a ported policyWhen you port or migrate a health policy, earlier years count for waiting periods and the moratorium. How to check a rejection that ignored them.
The hospital stay
- “Less than 24 hours in hospital”Why the 24-hour rule doesn’t apply to day-care procedures, how policies define day care, and how to challenge a short-stay claim rejection.
- “Admission not medically necessary”Insurer says admission wasn’t needed? How policies define medically necessary treatment, what evidence matters, and how to challenge the rejection.
- Cashless refused at the hospitalInsurer refused cashless at the hospital? The IRDAI 1-hour and 3-hour rules, how to switch to a reimbursement claim, and how to challenge the refusal.
- Discharge held up waiting for approvalIRDAI says the insurer must approve final discharge within 3 hours of the hospital’s request, and bear any extra charge caused by a delay.
Paid less than the bill
- Non-payables, consumables, co-pay or “reasonable and customary” cutsNon-payables, consumables, ‘reasonable and customary’ cuts, co-pay and sub-limits: what the rules require and how to challenge each deduction.
- Room-rent limit and proportionate deductionHow room-rent caps and proportionate deductions work after the 2024 changes, what still binds insurers, and how to challenge an unfair cut.
- Robotic surgery or modern treatment sub-limitIRDAI lists modern treatments insurers should try to cover, like robotic surgery and immunotherapy. How sub-limits apply and how to challenge a cut.
Paperwork and delay
- “Documents not submitted” or “late intimation”IRDAI says no claim shall be rejected or closed for want of documents or delayed intimation. What that means, and how to get a closed claim reopened.
- Claim not settled for weeksReimbursement claims must be settled within 15 days of submission, with interest at bank rate plus 2% if late. How to chase a delayed health claim.
The type of treatment
- Mental illness “not covered”The Mental Healthcare Act 2017 says insurers must cover mental illness on the same basis as physical illness. What that means for a rejected claim.
- Ayurveda or other AYUSH treatment refusedIRDAI requires insurers to place AYUSH treatment at par with other treatments. How policies define an AYUSH hospital, and how to challenge a rejection.
- Maternity claim rejected or cutMaternity cover is set by your policy’s own terms: waiting period, sub-limit and what counts. How to check a rejected or cut maternity claim.
- A senior citizen’s claim rejectedA separate channel for senior citizens’ claims, no refusal of renewal over past claims, and the rules most used. Help for families acting for a parent.
Not sure which applies? Start with what to do when a health claim is rejected, or use a free tool to check your dates.
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