How to assure that one’s Insurance Claim is not declined?

Insurance is purchased to secure oneself financially in case of any unforeseen mishaps. Insurance is a way of managing risks. However, when the Insurance Company rejects a claim, the buyer and his beneficiaries are often at the receiving end and are exposed to financial loss and disappointment.

To avoid any complications at the time of claim settlement, one must meticulously follow the terms and conditions mentioned in the policy document.

Life Insurance

Life insurance intends to provide financial backing and protection for the family in case of the policyholder’s unfortunate demise during the policy term. Here are some key aspects to keep in mind in order to ensure that your claim doesn’t get rejected.

8 Ways to Avoid Life Insurance Claim Rejection

1. It is extremely important to fill the application form yourself: At the time of purchasing insurance, make sure you fill in the proposal or application form yourself. You should ensure that your insurance provider is lucid concerning all material facts surrounding you. Disclose all facts without obscuring or concealing anything.
2. Avoid delaying filling in your claims: It may not be a priority in your mind in a medical emergency, but it would be sensible to give your insurance information to a trusted friend or relative to call and inform the insurance company if you are unable to intimate them yourself. A step as simple as this can decrease your woes and worries tenfold. As per the insurance contract, the company needs to be kept informed about the occurrences for which the claim is reported to them.
3. Medical Examinations: Insurance companies might sponsor medical tests better to understand the medical condition of a prospective buyer to test the suitability of a buyer for their policy. These tests might also help the insured to detect diseases early and treat them accordingly.
4. Examine policy documents discreetly: Always read your policy document to confirm whether your needed services and procedures are covered in a satisfactory manner in the contract. There could be a possibility that the insurance provider incorporates a wrong detail, and hence it would be prudent to go through the policy document thoroughly immediately on receipt.
5. Avoid willful suppression of Facts: Giving false information in the application form can eventually lead to rejection of a Life Insurance Claim. Therefore, one should fill in correct and precise details such as age, income, occupation, lifestyle(smoking/drinking), details of previous or other existing policies, claims taken if any, and additional information in the proposal form correctly. Any factually incorrect information might be considered “material misrepresentation” and might lead to suspension of policy benefits.
6. Avoid wrong disclosure of facts: You should fill in all the essential details such as age, occupation, income, lifestyle habits like smoking/ drinking, details of previous/other existing policies, claims taken if any, as well as other related information in the proposal form correctly. Any incorrect information is considered “material misrepresentation,” which can result in a policy cancellation. However, many insurance companies deny a valid claim if they find a misrepresentation/non-disclosure in the proposal form is not material.
7. Timely Payment of Premiums: Insurance companies often consider non-payment of premiums as a reason to deny claims. Therefore, it becomes necessary for the policyholder to pay the insurance premiums on time. However, the insured or beneficiary has the right to know whether the insurer sent ‘premium-due notices’ to the correct address and whether the notice warned against the impending lapse.
8. Name of the beneficiary/nominee being mentioned: Upon the insured’s death, the benefits are paid to the policy nominee or the beneficiary. It is, therefore, necessary that the insured mention the name of the beneficiary in the policy with updated details about their address, contact number, etc. When a beneficiary is not named, the claims might get rejected or delayed.

Health Insurance

Claims can also get rejected in the case of health insurance policies. So here are some preventive measures that should be taken to avoid rejection of health insurance claims

4 Ways to Avoid Health Insurance Claim Rejection

1. Provide correct information in the proposal form: Any wrong information such as age, income, lifestyle habits, medical history, etc., might lead to rejection of the claim along with termination of the policy. In addition, most health insurers do not cover pre-existing diseases (PED); therefore, asking for a claim in respect to PED will be a waste of time and effort.
2. Ensure timely policy renewal: It is necessary to renew the policy on time. Even if the insured gets admitted to the hospital only after a day later of expiry, he/she is not entitled to claim.
3. Intimate insurer within mentioned time: Most health insurance policies clearly mandate that the insurer must be intimated within 24 (or in some cases 48) hours of hospitalization. Moreover, it is always prudent to take the policy from an insurance provider who is readily available 24×7 so that the insured can comply with this condition.
4. Be aware of the exclusion list: Make sure to go through the exclusions in a health insurance policy to avail a hassle-free claim settlement process.

So, before making a claim, make sure you go through all the points mentioned earlier to ensure that your claim does not get rejected.