It is disappointing when you file a claim under your health insurance policy but it is rejected or repudiated. According to a survey done by Local Circles, many health insurance claims have been denied or partially approved in India in the last 3 years. On further research, it was found:
An insurer’s claim settlement process is a hallmark of trust and reliability with the customers. This article extensively talks about claim repudiated and claim rejection, its reasons, and more. Stick around to find out how you can prevent your claims from rejection and repudiation.
Key Takeaways
Claim repudiation happens when the policyholder conducts some fraudulent activities while filing a claim. The fraudulent activities can vary from forged documents to missing out on medical condition disclosures, or more.
It is essential that you as a policyholder understand the terms and conditions of your health insurance plan to avoid future claim repudiation.
Some common reasons for claim repudiation are:
Claim rejection is often the result when the policyholder files a claim for a procedure or treatment that is not covered by their health policy. Often when a claim filed is not within the terms and conditions of the coverage offered by the health insurance policy, it is rejected.
Common reasons for claim rejection are mentioned below:
Let us understand the difference between claim repudiated and rejections below:
Claim Repudiated | Claim Rejected |
---|---|
Claim repudiation is the result of fraudulent activities by the policyholder like submitting false documents, withholding medical conditions, etc. | Rejected health claims are a result of the health insurance provider not deeming your claim request to be fit. The claim request can be reviewed and re-applied. |
Reasons for repudiation include claiming after policy lapse, providing forged documents, policy violation, etc. | Reasons for rejection include claiming during the waiting period, hiding PED conditions, etc. |
If your claim is repudiated, do not worry. Follow these simple steps to file a proper claim request:
Try and figure out the reason for your claim repudiation and rejection to have a smooth claim settlement process. The reason behind claim repudiation and claim rejection can be easily identified and rectified.
In case you are stuck in the process do not hesitate to seek professional advice from insurance experts at PolicyX.
The difference between claim repudiation and claim rejection is very little depending on the consequences leading to rejection and repudiation. In case of claim repudiation, the policyholder conducts some fraudulent activities whereas rejection can be due to withholding vital health information from the insurer like PEDs, lifestyle habits (smoking/ consuming alcohol), etc. or due to exclusions of the health policy.
Claim repudiation means the rejection of a contract by breach of terms and conditions.
A claim rejection is the result of wrong information provided by the policyholder or filing a claim for coverage that is not included in the health policy.
Claim rejection reasons may include filing a claim within the initial waiting period, incorrect submission of documents, filing a claim for pre-existing diseases which are not covered by your health insurance plan, etc.
Common reasons for claim repudiation include, fraudulent documents, misinformation regarding medical history, forging documents, etc.
Know More About Health Insurance Companies
5
Rated by 1 customers
Select Your Rating
Let us know about your experience or any feedback that might help us serve you better in future.
Simran is an insurance expert with more than 3 years of experience in the industry. She may have all the answers to your insurance queries. With a background in Banking, she proactively helps her readers to stay on par with all the latest Insurance industry developments.
Do you have any thoughts you’d like to share?