An insurance claim is essentially bought not only to shield your family against unforeseen events that may have a damaging impact on their future. These events may include the sudden death of the family’s breadwinner or unforeseen health emergencies involving costly bills for hospitalization and subsequent treatment. Some also buy insurance plans as a part of their retirement planning to fund their children’s higher education and marriage.
Considering how paying for insurance is equivalent to long-term security that can affect your family’s finances in the long run, it becomes necessary to adopt measures that enhance your family’s chances of securing the claim.
Lies or untruthful submission of details can hurt
Not many policyholders take the pain to go through the document and understand the information the insurance company requires of you. This results in either sharing of wrong or incomplete information. Name spelt wrongly, withholding insurance history or other information regarding the insured are common reasons for claim rejection.
Any anomaly in the information you had submitted in the proposal form will hurt while making the insurance claims. Most of the time, the blunder is committed as policyholders leave it to the insurance agents to fill up the details while not taking care to check if any vital detail may have been left out.
Leaving the document to the agent for him or her to fill in the details is a blunder that can destroy all your chances of seeking the claim in future.
To start with, remember to share all necessary details with the insurance company. This means that you cannot afford to lie about your lifestyle including smoking or drinking habits. It does not matter whether you smoke or drink regularly or occasionally. The most common reasons for health insurance claims rejection include non-disclosure of conditions including diabetes, hypertension, thyroid problems, previous surgeries, etc.
Priya Deshmukh Gilbile, Chief Operating Officer, ManipalCigna Health Insurance says, “It is very important to make the right disclosures of our lifestyle habits and pre-existing diseases while buying a health cover as it helps the insurers to price the risk accordingly. If the customer makes the disclosures upfront during the process of underwriting then there would not be any conflict or questions raised in the future on grounds of non-disclosure. Every health insurance company wants to settle the policyholders’ claims and it’s a moment of truth for the insurer, but to successfully enable the claims settlement process, firstly the health insurance provider needs to understand the nature of risk and calculate the premium to cover that risk at the time of underwriting the policy. Therefore, it’s a wise decision to inform the health insurance company about your lifestyle habits and pre-existing health conditions, as the health insurance policy is issued based on utmost good faith and therefore, hiding your existing conditions is a breach of this faith. Moreover, policyholders need to disclose their medical conditions accurately their health and not just in the present but also in the past. If the customer has any pre-existing illnesses which are not listed in the proposal form. Also, the policyholder should disclose any surgery they have undergone, any accident or injury they have had in the last five years and if they are taking any regular medicines.”
You must also take care to declare the correct salary and Income Tax Return (ITR) details while purchasing a life insurance cover. Irrespective of why you are buying the insurance policy, remember to share every detail correctly.
Every insurance policy contains a set of questions designed and framed in a way to enable the insurance company to understand their prospective customers, the kind and amount of insurance they must seek and the corresponding premiums they must pay. The insurance company expects the insurance proposer to fill in all the information correctly.
Some people find it unnecessary to list the old policies they hold at the time of applying for the new policy. This can be one of the grounds for the insurance company to reject your claim.
Discharge summary matters
Not all may be wrong at your end. Many policyholders have faced health insurance rejections simply because the hospital had submitted incomplete or wrong details in their discharge summaries. While being discharged from hospitals, make sure that all details are listed and detailed in the discharge summary to avoid rejection of the claim(s) made. An innocuous error by the hospital staff can ruin your chances of getting your treatment bills compensated and paid for by the insurance company.
Occupational details
What you do matters to the insurance company and that is why they are intent on knowing your job and income details. Remember to furnish correct information regarding your occupation at the time of seeking the insurance cover. It does not matter if you are salaried or engaged in some business activity. Insurers want to know the nature of your job to check if you are involved in high-risk occupations. Insurance companies will charge a higher premium if you are involved in a job that poses a high risk to your health or life. Though there would be a loading on the premium, sharing correct details will ensure that the insurance company pays the claim amount when it is needed.
Keep your insurer informed
Make sure to inform your insurance company immediately after raising the claim. You can do so via email or call the customer care centre number or enter the details in your app. Ensure that the mobile number and email id mentioned in the policy document is correct so that the company officials can contact you when necessary. Make sure to submit all the required documents in one go at the time of claim submission to ensure that there are no delays in the claim processing and settlement process.
If it is a life insurance policy, you must be very careful about the nominee details that you submit in the policy document. All details of the nominee(s) including name, age, date of birth and nature of the relationship must be carefully mentioned to avoid mismatch and rejection claims at a later stage. Also, in case of sudden and unfortunate death of the nominee, fill in details of the legal heir in the policy document. This change in nomination must be affected across the entire policy document along with the submission of relevant papers and details.
Claim rejection can be painful and a hard blow to your family in unfortunate circumstances. To insure is to secure. However, you must be careful about the information that must go into the policy to ensure complete security in the future. Being vigilant at the time of buying the policy or making policy claims can save you from a lot of unwarranted heartaches due to claim rejection by the insurance company.
