Hassles During Health Insurance Claim Settlement

Hassles During Health Insurance Claim Settlement


You may have taken a health insurance policy, but as with any process involving money and documents, the claim settlement may encounter roadblocks. Even the insurance company’s claim settlement ratio is not solid enough to go by. What is the claim settlement ratio? It is the ratio of the number of claims settled by the company to the total number of claims received by them. This percentage is usually above 90% for good (or old) companies. But this is also no guarantee for a hassle-free settlement process. The following are some issues that may come up during health insurance claim settlement:

  • There might be a delay in processing the claim – sometimes up to six months or even a year. IRDAI reports show that a lot of life insurance claims remain unsettled for over a year before the final settlement is made
  • The long waiting period for claims is another issue with insurance policies, which goes against the policy of timely disbursement in times of need
  • You may be asked to submit a document after document for verification before your claim is settled
  • Carelessness while filling the form at the time of purchasing the policy, not going through all its terms and conditions, and not familiarising yourself with its scope and coverage, can all place you at a severe disadvantage at the time of cashing the claim

Battling with these obstacles can get really frustrating because what you thought would have your back in a health crisis is actually causing more trouble. Although insurance companies are also to be blamed for some mix-ups and delays, there are some measures that can be taken at the policyholder’s end in order to avoid any hassle. Here are some tips:

  1. Provide accurate information

Giving incorrect information in the form can result in the whole claim being rejected. You should be honest and disclose all information that is asked for – such as pre-existing health conditions, lifestyle habits such as smoking and drinking, age, income, etc.

  1. Pay premium regularly

Skipping or delaying premium payment is not an option. If genuine circumstances render your incapable of paying the premium after a while, make sure that you inform your insurance company and follow their directions.

  1. Be well-informed

Go through every detail of the policy before purchasing it, including its clauses and exclusions. You must be armed with information about the formalities, requirements, claim settlement process, your rights, and the redressal mechanism.

  1. Update regularly

Any changes in your personal information or the beneficiary’s information should be made known to the insurance company. Obsolete information will inconvenience both you and the insurer during the claim settlement process.

  1. Create an e-insurance account

Maintaining an online account for policy documents and information reduces paperwork and minimises the scope for error. You can also access it round-the-clock, quite easily.

  1. Keep documents safe

If all documents are in place, you will be in a better position to question the insurance company and urge them to hasten the process. You can produce whatever document is required and prevent wastage of time.

  1. Register the claim early

Notify the insurance company via application before you file a claim. This way, the company can initiate the claim settlement process quickly and delays can be prevented.

If you follow all these steps, your claim settlement process will be a smooth ride. You don’t have to worry about finances and can focus entirely on your health.

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