Reasons Why Your Insurance Claim Is Not Being Admitted

The on-going pandemic has not only put a strain on the health workers, but also the health insurance providers. The claim requests are piling on with

The on-going pandemic has not only put a strain on the health workers, but also the health insurance providers. The claim requests are piling on with each passing day. In such challenging times, the insurers in India are either not admitting the claims or compensating with high deductions.

Let us take a look at the reasons why there are high deductions in claims in India.

  1. High Room Rents

Usually, the room rent is covered in your health insurance claim amount. However, there is a cap limit to that expense. In case you opt for a room in the hospital that charges you more than the available cap limit, the remaining amount will not be covered in the health insurance claim settlement.

For instance, let us consider that your health insurance provides Rs. 3000 as daily room rent allowance. Now, if you opt for a room with a daily fee of Rs. 4000, then your insurance will only compensate Rs. 3000 and you will be liable to pay the remaining Rs. 1000.

  1. 24 hours of Hospitalization

In most health insurance plans, it is mandatory to wait at least 24 hours after hospitalisation to raise a claim request. If your health plan covers daycare charges, it will be mentioned in the policy explicitly. Otherwise, you have to bear the expenses from your pocket.

  1. Waiting Period

Health insurance comes with a waiting period for certain ailments. Usually, it is up to two to four years for pre-existing diseases. Until the waiting period ends, any claims raised related to the mentioned diseases will be denied. On the other hand, most health insurance has a standard waiting period of 30 days. During this time, no claims are admitted by the insurer.

  1. Copayment

In order to reduce health insurance premiums, most people opt for a copayment. A copayment is nothing but a clause in health policies that make the policyholder liable to cover a specific percentage on the claim amount. That means, if you (the insured) have opted for 20% copayment, then you will have to bear the 20% of the total claim amount from your pocket. The insurer will compensate for the remaining 80%.

  1. Exclusions 

Besides covering a wide range of health issues, health plans come with certain limitations. These limitations are mentioned in the health insurance exclusion section of your policy document. Any claims raised against the mentioned exclusions will not be entertained by the insurer and will lead to claim rejection.

Tips For Successful Claim Filing

If you want to make a successful claim on your health insurance plan, consider the following tips –

  • Make sure that you are paying the health insurance premiums on time. Any delay or lapses in paying the health premiums can lead to policy termination. During such a time, if your health degrades, you will not be able to claim on the health insurance policy as it is inactive.
  • When buying health insurance in India, ensure that you are submitting relevant and truthful information to your insurer. Any discrepancy in your details can lead to health insurance claim rejections in the future.
  • It is recommended to understand the exclusions in your health policy before you buy it. In case you happen to raise a claim against any exclusion, it will lead to claim rejection.
  • You must follow the health insurance claim process, as explained by your insurer.


We understand that times are challenging at the moment. If there comes a need to raise a claim on your health insurance plan, make sure you and your dependents are well versed with the process and terms of the policy. All this will help you make a successful claim on your health plan.