Categorized | General Insurance

how to avoid claim rejections?


You have the best insurance Policy in town, and are Assured that when in need you and your family are financially secure. However, you are jittery during the filing of claims because this is the most critical time when you really need money in lump sum, and you are unsure if your Claim will be accepted. This could be primarily because you have come across instances where claims were rejected and there seemed to be no valid reason for doing so.

A claim typically arises only in cases such as death or permanent disability. The condition under which an insurance claim is usually made is one of despair and sorrow. While you cannot change the situation, a claim at least lessens the financial burden on the family. This is more important in those cases where the Insured was the one and only breadwinner of the family. The importance of fast, easy and hassle-free claim settlement experience assumes greater significance in such difficult circumstances.

Insurance companies have a duty towards shareholders to ensure that only genuine claims are accepted. There must be measures in place to ensure that only true claims are taken care of and bogus ones rejected. Otherwise, genuine customers will suffer because accepting bogus claims will cost more in the form of higher premiums.

Also, you must not give the Insurer a chance to reject your claim. It is important that you are honest in your declarations and abide by the policy agreement. You must follow all rules, policies and procedures given in the insurance documents. If you give accurate information and follow the rules, there are adequate set of laws to protect your rights as a customer. A company that is in the business of insurance and paying claims would not actually like to spoil its reputation by rejecting claims. 

So there could be few reasons why claims are actually rejected, and cause misunderstanding too between the company and the customer. Here are the main reasons why things generally go wrong:

•Incorrect or incomplete information regarding age, occupation, income, treatments taken earlier and so on.

•Non-disclosure of Pre-existing illnesses, especially if they are of the serious kind.
For example, Cancer, HIV, ailments of the lungs or liver, heart-related illnesses, high-BP, smoking and alcohol habits and so on.

Here is a checklist of things you can do to keep your insurance claim clean and hassle free:

•Declare correct or complete information regarding age, occupation, income, treatments taken earlier and so on.

•Submit all claim documents properly filled in, accurately and truthfully, and in a timely manner.

•Ensure that nominations are made in the contractual documents, the nominations are correct, and the nominee knows all the details regarding the nomination.

•You must know your plan and its benefits completely. Also, understand the contract terms and conditions well.

•Last but not the least, you may look at the average number of claim settlement of companies whose products you are planning to buy.

If you indulge in non-disclosure, partial disclosure or wrongful disclosure of important facts, they are good enough reason for rejection of insurance claims. If the insurer comes to know of false claims, your claim gets rejected as per the contractual terms and conditions, and there is often little room for reconsideration. Hence you must lay the foundation for a hassle-free claim at the time of acquiring the policy itself and not at the time of actually making the claim.