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Common reasons why your health insurance claim can be rejected

There is a proverb “Health is Wealth”. This proverb makes more sense when you feel the pinch of spending a huge sum of money on your treatment. Buying health insurance is an amazing way to manage your finances in case you need to avail it for treatment. Hence, everyone must realize the importance of being covered under health insurance. However, at times your claim gets rejected, to your utter disbelief and you may face claim-related issues which increase your financial woes.

But the question that might worry you is why my health insurance got rejected despite the fact it was bought from known sources. In this blog, we will discuss the reasons behind the rejection for such claims to prevent mishaps in the future in times of medical need. 

Top 5 reasons why health insurance claims get rejected

Rejection of your claim, especially when it comes to medical treatment leads to many health insurance-related complaints. There are many reasons for denying your health insurance claim. At first, you need to know the reasons behind the rejection and then take the necessary measures. So, let’s know the common reasons for which settlement can be rejected. 

1. Wrong information 

Wrong disclosure or partial disclosure of facts is one of the common reasons for denying your claim. Health coverage is provided to the insured person on the basis of information on the proposal form. Thus, any non-disclosure or misrepresentation of facts while filling up the form can lead to its claim rejection. 

2. Non-coverage of pre-existing disease

Most of the time, the policyholders unknowingly buy health insurance to cover the future illness and do not disclose the pre-existing illness. Some insurance companies do not cover any pre-existing diseases and refuse to give settlement amount of the treatment, which gives rise to many health insurance complaints. Also, even if such policy covers pre-existing medical conditions, then there is a waiting period to get the claims. 

3. Ignoring the waiting period

To avail your health insurance, you need to wait for a certain period of time. The waiting period varies according to the terms and conditions of the insurance companies. In case you claim your settlement amount before the waiting period, it is obvious your claim will be rejected. 

4. Exceeding the sum assured 

Whenever you buy an insurance policy there is a sum assured which is the amount paid to the policyholder in case of any emergency. If you have utilized the sum assured based on your chosen plan while claiming your insurance, it will get rejected. 

5. Failing to renew the policy 

In many cases, your health insurance claim gets rejected if you fail to renew the policy on time. Moreover, if you renew your lapsed policy, it leads to claim-related issues when the insured avail the amount in this gap period. Hence it is advisable mandating the auto-debit process to make sure that your policy gets automatically renewed. 


While purchasing an insurance policy, always buy one that matches your requirements. Also, avoid making hasty decisions while filling out the form to avoid rejection while claiming the settlement amount.