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Health insurers reject majority of claims because policyholders are not aware of terms and conditions of the health policy like exclusions and sub limits, reveals a report released by online insurance broker PolicyBazaar.com.
Further, the report says that even if a policyholder makes claim request, she is not able to address queries and flags raised by the insurance companies.
Other reasons for claim rejection include making claim request during waiting period, non-disclosure of health condition at the time of buying it and making claim request multiple times after exhaustion of sum insured.
Let us look at this table to know more:
|
Reasons for claim rejection |
Claims rejected (in % terms) |
|
Policy T&C not met |
36% |
|
Insurer query not addressed |
19% |
|
Waiting period not completed |
15% |
|
Non-disclosure |
12% |
|
Other |
19% |
In the report, the online distributor said, “While on the one hand consumer education is important to ensure they understand their policies as well as the need to be transparent when purchasing the policy; on the other hand, simplification of the process and on ground support are important for a better claim experience and retention.”
Please note that the report covered claim requests between October 2022 and February 2023.