Health insurance is a safeguard against life's uncertainties, offering financial security during
medical emergencies. While finding the correct health insurance is critical, being aware of
potential hazards that could lead to insurance claim-related issues is also necessary.
Let us look at the case of Satwant Kaur Sandhu V. New India Assurance Company Limited.
This case is about a disagreement over an insurance claim for medical expenses. The person
insured, the appellant's husband, passed away due to chronic health issues. The insurance
company rejected the claim, saying important health information was not shared when applying
for the policy.
Both the State and National Commissions agreed with the rejection. The court decided the
insurance company was right to reject the claim because the insured didn't honestly share
crucial health details. The court called the claim fraudulent and dismissed the appeal without
any additional costs.
It stressed that people must share all important health information when applying for insurance.
The court found no good reason to change the decision and didn't send the case back for
another review.
This case highlights the need to provide complete and honest disclosure of essential
information when applying for insurance. It accentuates the importance of providing accurate
information about one's health while applying for insurance coverage, such as a health
insurance policy.
Here's a list of what NOT to do in health insurance claims.
1. Don't ignore policy details.
One of the cardinal sins in health insurance is neglecting to thoroughly read and understand the
policy details. Ignoring the fine print will always result in surprises you would not like when you
file a claim. Be vigilant about policy renewal dates and ensure that you renew on time.
2. Don't delay premium payments
Timely payment of premiums is the lifeblood of your health insurance policy. Skipping or
delaying payments can lead to policy lapses, rendering you without coverage precisely when
you need it the most.
3. Don't withhold information
Failure to disclose medical histories or provide false information might result in claim denials.
To avoid future issues, be open about your medical history during the application process.
4. Don't assume all treatments are covered.
Every health insurance coverage has some limitations. Assuming that all medical procedures
are covered is an expensive mistake. Examine the specifics of your coverage, paying special
attention to exclusions.
5. Don't overlook network restrictions.
Often, Health insurance plans include a network of healthcare providers. Neglecting to use innetwork facilities can result in higher out-of-pocket expenses or even denial of claims.
6. Don't postpone claim filings
After a medical event, don't procrastinate filing your insurance claim. Many policies have a
specified timeframe within which claims must be submitted. Failing to adhere to these timelines
might result in claim rejections.
7. Don't forget to keep records
Documentation is key in the world of health insurance. Keep detailed records of medical bills,
prescriptions, and any communication with your insurance provider.
By avoiding these frequent "don'ts," you can dramatically lower your likelihood of facing
insurance claim-related issues. Despite exercising all caution, if your health insurance is still
rejected, it is advisable to consult with subject matter experts to help you realize a wrongfully
denied claim.
