Health insurance acts as a cushion during medical emergencies. It protects our hard-earned money from going into hospital bills. However, it is not rare that insurance companies reject lakhs of claims every year. The reason for many rejections may not be appropriate. Insurance companies have also rejected many claims of covid-19. However, if your claim is genuine and you feel that the insurance company is willfully rejecting your claim on false grounds, you can go to the insurance ombudsman. In this article, we will see how you can claim your right with the help of ombudsman.
What you must do at first?
Whenever the insurance company rejects a health insurance claim, it informs the insured person in writing of the reasons for rejecting the claim. If your claim is genuine and you feel that the reasons for rejecting the claim by the insurance company are not correct, then you must inform the insurance company in writing by registered post as to why the reasons for rejection of the claim by them are not justified.
After informing the company, send a copy of your protest letter to IRDAI email id email@example.com and the Grievance Cell of the company’s head office.
If the insurance company does not accept or notify your claim within a month even after your protest letter, then you must register your complaint with the Insurance Ombudsman of your area.
How to reach an insurance ombudsman?
- The insured person can register his complaint to the Insurance Ombudsman by writing an application and send it through registered post and email.
- Details: In this application, you have fill the name of the insured, signature, policy number of the insurance, insurance claim number, how much the claim is worth.
- After drafting the application with above details. Fill the complete address with pin code, phone number, email id, name of the insurance company and the address of the office from where the policy is taken.
- You must attach a copy of the hospital bill, doctor’s prescription, investigation report, rejection letter from the insurance company with the complaint.
- In the complaint application, you must quote the reasons for the claim rejection given by the insurance company, and the reasons why your claim is genuine.
Other things you must know:
A complaint to the Insurance Ombudsman can be given by letter, in person or by post. Complaint to the Insurance Ombudsman can be made by the insured or by the heir of the insured. However, if a claim case is pending in the consumer court, then the complaint cannot be made to the Insurance Ombudsman. No fee is charged for complaints in the Insurance Ombudsman.