Health Insurance: Has the insurance company rejected your claim even after continuously paying the health insurance premium? In such a situation, we are giving information about what options the customers have.
Health Insurance Claim: Health insurance is considered as an excellent option to overcome the worry of expenses incurred due to diseases. Health insurance policy is very useful in case of sudden illness, but it has also been seen many times that even after paying the premium for years, insurance companies reject the claims of the customers.
In such a situation, it is no less than a shock for the policy holder. If something like this has happened to you too, then we tell you what rights you have. What can you do in case your health insurance claim is rejected?
What can you do if your health insurance claim is rejected?
According to the report of Economic Times, there can be many reasons behind rejection of health insurance claim. Usually, the insurance company tells the customers the reason behind claim rejection. Giving wrong information or not giving correct information about previous illness can be the main reasons for this.
If you are dissatisfied with the company’s argument, then in such a situation you can complain about it to the Grievance Redressal Officer (GRO) of the company. After this, customers also have the option to contact the Ombudsman.
The thing to note is that if the insurance company rejects the claim within the insurance amount, then the policy holder should lodge his complaint with the company. After this, he also has the option to file a complaint in Lokpal and Consumer Court.
You can also complain to IRDAI
Insurance regulator IRDAI has issued a toll-free number 155255 or 1800 4254 732 to resolve health insurance related complaints of customers. Apart from this, you can also settle the matter by sending an email to @ irdai.gov.in . Apart from this, you can also register your complaint online by visiting the integrated complaint portal of IRDAI.
Keep in mind that if the customer is not able to lodge his complaint directly with the insurance company, then in such a situation the complaint portal of IRDAI provides a channel for him to lodge his complaint with the companies.
Where to appeal first
According to experts, after filing a complaint with the insurance company and in case of no hearing, the customer can go to the Lokpal or the Consumer Court, but experts consider it better to go to the Lokpal first.
With this, your hearing can be done faster and the case can be disposed of quickly. Usually, such cases are heard quickly in the Lokpal. If the decision of the Lokpal is not in favor of the insured, then you also have the option of going to the consumer court.
