Health insurance claim rejected? Here's how to fight back.

A hospitalisation is stressful enough without a claim rejection on top of it. Whether your cashless request was denied at admission, your reimbursement was rejected after discharge, or you were paid far less than the bill, ClaimsKart reviews your case and challenges the decision where it doesn't hold up.

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Health insurance · Reimbursement

₹3,84,000

Rejection received
“Pre-existing condition not disclosed”
04 Mar
AI-MIL review
Condition began after the policy started
06 Mar
Grievance filed with insurer
With medical records and policy wording
09 Mar
Insurance Ombudsman
Hearing after 30 days unresolved
18 Apr
Settlement credited
Paid in full to the policyholder
21 May

Illustrative example, not a real case.

Why health claims get rejected

These are the reasons insurers give most often. Many don't survive a careful reading of the policy.

Non-disclosure of a pre-existing condition
Claim made during the policy's waiting period
Treatment called "not medically necessary" or not needing hospitalisation
Hospital not on the insurer's network list
Incomplete or inconsistent documents
Room-rent limits and sub-limits used to short-settle the claim
Claim intimated after the permitted window

How ClaimsKart helps

Cashless denial appeals
We push back on TPA (third-party administrator) rejections while you are still at the hospital.
Reimbursement review
We re-examine bills, the discharge summary and the policy clauses when a claim is rejected after treatment.
Short-settlement disputes
If you were paid less than the eligible amount, we recalculate it and contest the shortfall.
Pre-existing disease disputes
We check whether the non-disclosure allegation is medically and factually accurate.
Escalation
If the insurer won't move, we take the case to the Insurance Ombudsman or a Consumer Commission.

If the insurer won't move, we escalate.

Your claim can go up through every redressal forum in India. We tell you at each step whether going further is worth it.

+91 70907 00771 WhatsApp usMon–Sat, 9 am – 7 pm IST

01Insurer grievance cell
A formal written grievance, within IRDAI-mandated timelines.
02Legal notice to the insurer
A legally drafted notice citing the relevant clauses and IRDAI guidelines.
03IRDAI Bima Bharosa
A complaint on the regulator's grievance system.
04Insurance Ombudsman
If the grievance is unresolved after 30 days, with full hearing representation.
05Jurisdictional courts
Filing and representation for local disputes.
06District Consumer Commission
Filing and representation for local consumer disputes.
07State Consumer Commission
For higher-value claims and appeals.
08National Commission (NCDRC)
For complex, high-value, national-level disputes.
09Supreme Court of India
With Advocates-on-Record and Senior Counsel, where a matter needs the highest court.