Insurance claim reject hone ke reason samajhna zaroori hai. Yah article batata hai top 5 common reasons aur unke solutions taaki aapka next claim 100% approve ho.
💡 Introduction
Aapne insurance liya taaki mushkil waqt me financial support mil sake — chahe wo health insurance, life insurance ya vehicle insurance ho. Lekin jab claim karne ka time aata hai aur claim reject hone ka notice milta hai, to dil toot jata hai 💔.
Actually, har saal India me hazaron logon ke insurance claim reject ho jaate hain — sirf isliye kyunki unhone kuch basic rules follow nahi kiye.
To aaj hum baat karenge claim reject hone ke 5 common reasons ke baare me aur unke smart solutions, taaki aapka next claim reject na ho.
🔹 1. Incorrect or Incomplete Information
⚠️ Problem:
Claim reject hone ke reason me sabse common hai — galat ya adhura information dena.
Kai log proposal form me apni health history, smoking habit, ya past illness chhupa lete hain.
Insurance company jab claim verify karti hai aur ye chhupi hui details milti hain, to wo claim reject kar deti hai.
✅ Solution:
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Policy form bharte waqt har detail sach aur complete likhiye.
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Agar aapko koi disease hai (jaise diabetes, BP), to mention zaroor karein.
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Income, address, nominee details bhi updated rakhiye.
💡 Remember: Honesty is the best policy — especially insurance me!
👉 Focus Keyword use: claim reject hone ke reason me sabse bada factor incomplete details hota hai.
🔹 2. Policy Lapse Ya Premium Miss Hona
⚠️ Problem:
Kai baar policy holder premium time pe pay nahi karta. Jab policy lapse ho jati hai aur uske baad claim aata hai, to company reject kar deti hai.
Expired policy par claim legally valid nahi hota, chahe aap saal bhar premium bharte aaye ho.
✅ Solution:
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Premium due date ka reminder set karein (SMS/Email alert).
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Auto-debit ya ECS option on rakhein.
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Agar policy lapse ho gayi hai, to revival period me renew kara lijiye.
💡 Tip: Policy lapse bhi claim reject hone ke reason me top position par aata hai.
🔹 3. Non-Disclosure of Pre-Existing Disease
⚠️ Problem:
Health insurance me sabse zyada claim reject hone ke reason hota hai — pre-existing illness chhupana.
Agar aapko pehle se diabetes, BP, heart issue ya liver problem thi aur aapne mention nahi kiya, to insurer claim deny kar deta hai.
✅ Solution:
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Application me clearly likhiye ki aapko kya-kya medical condition hai.
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Doctor ke reports, test results attach kar dijiyega.
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Policy choose karte waqt “Pre-existing Disease Cover” option select karein.
📋 Example: Agar aapne heart problem hide ki aur 6 mahine baad heart surgery ka claim dala, to wo reject ho sakta hai.
🔹 4. Wrong Claim Process Follow Karna
⚠️ Problem:
Kai log claim process properly follow nahi karte — jaise required documents late submit karna, hospital se incomplete bill dena, ya insurance company ko inform na karna.
Company ko lagta hai ki claim fake ya incomplete hai, aur wo reject kar deti hai.
✅ Solution:
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Claim karte waqt TAT (Turn Around Time) follow karein — har company ka specific period hota hai (e.g., 7 days after discharge).
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Sabhi original documents, hospital bills, discharge summary submit karein.
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Insurance company ko email/helpline ke through turant inform karein.
💡 Tip: Agar aap step miss karte ho, to ye bhi claim reject hone ke reason me count hota hai.
🔹 5. Policy Terms Aur Exclusions Ka Galat Samajhna
⚠️ Problem:
Kai log apni policy ke terms and conditions padte hi nahi. Example – kuch policies me certain diseases, accidents, ya suicide cases cover nahi hote.
Phir jab usi reason se claim lagta hai, to company easily reject kar deti hai.
✅ Solution:
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Policy lene ke baad terms & exclusions dhyan se padho.
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“Cooling period” ke 15 din me agar kuch galat lage to policy cancel kara sakte ho.
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Confusion ho to agent ya customer support se confirm kar lo.
💬 Example:
Health insurance me “cosmetic surgery” covered nahi hota — fir bhi log uska claim daal dete hain, aur wo reject hota hai.
👉 Hence, policy understanding ka lack bhi ek major claim reject hone ke reason hai.
📘 Bonus Tip – Claim Approval Chances Kaise Badhayein
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All documents ready rakhein: Aadhaar, policy copy, bills, ID proof.
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Hospital tie-up check karein: Cashless claim me delay nahi hota.
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Nominee updated rakhein: Wrong nominee se claim reject ho sakta hai.
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Insurance renewal kabhi miss na karein.
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Communication transparent rakhein: Koi bhi health update company ko batate rahein.
🧩 Conclusion
Insurance lena ek financial protection hai — lekin uska benefit tabhi milega jab aap claim sahi tarike se karein.
Ab aap jaante hain claim reject hone ke 5 common reasons, to in mistakes ko avoid karke apna claim 100% approval ke liye ready rakhiye.
Always remember 👇
“Sahi information aur timely action hi successful claim ki key hai.”
❓FAQ – Claim Reject Hone Ke Reason
Q1. Sabse common claim reject hone ke reason kya hai?
Ans: Incomplete information aur pre-existing disease hide karna sabse common reason hai.
Q2. Agar claim reject ho gaya to kya kar sakte hain?
Ans: Company ke grievance department me appeal karein, fir IRDAI ya insurance ombudsman ke paas complaint file karein.
Q3. Kya main claim reject hone ke baad dusri company se policy le sakta hoon?
Ans: Haan, lekin apna medical report honest rakhiye, warna same reason se fir rejection ho sakta hai.
Q4. Health claim ke liye kya documents chahiye hote hain?
Ans: Hospital bills, discharge summary, doctor report, ID proof, policy copy aur payment receipt.
Q5. Claim approve hone me kitna time lagta hai?
Ans: Normally 7–15 working days lagte hain, agar documents aur verification complete ho jaye to.
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