Health Insurance

Reasons Why Your COVID-19 Claim can be Rejected

Having an insurance cover is a must during these tough times of the COVID-19 pandemic. Health insurance is imperative to safeguard one’s investments because of the current coronavirus scenario and…

Having an insurance cover is a must during these tough times of the COVID-19 pandemic. Health insurance is imperative to safeguard one’s investments because of the current coronavirus scenario and the uncertainty of a medical emergency. Insurance Regulatory and Development Authority (IRDAI) has also come up with certain mandatory guidelines for all insurance companies in order to provide the maximum benefit to the policyholders. While many general, health and life insurance companies are providing policies with variations, they still have varying claim parameters. It is important for each one of us, who is a prospective or existing policyholder, to understand the various reasons why a claim is accepted or rejected. The main reason for having a health insurance policy is to get a claim settlement done during hospitalization. Due to coronavirus, various insurance policies especially covering COVID-19 have recently been launched. However, multiple reasons are attached to the rejection of a claim under a COVID- 19 insurance cover. Let’s understand the various claim parameters:

Reasons why your COVID-19 claim can be rejected -

1. Pre - Existing Disease:

If the insured as a pre-existing respiratory disease for a month or more than a month, there are high chances that both general, health and life insurance companies may reject the claim in this case. 

2. Pre - Existing Symptoms:

Adding on to this, if the policyholders have been suffering from cough, flu, respiratory issues, breathlessness, and planning to go for a treatment, only to find that the symptoms have transformed into coronavirus disease, the health insurance company might reject the claim.

3. Travel History:

If you or your family members have a recent travel history to any of the worst-hit coronavirus countries or cities, the insurance company could reject the claim. Additionally, if the policyholder gets COVID-19 without traveling anywhere but from his/her family member who has a travel history to selected countries such as China, Japan, Kuwait, Italy, Hong Kong, Macau, Thailand, Singapore, and others, then in this case also, the policy claim could get rejected.

4. Exclusions:

All insurance policies mention exclusions in their policy. Like, some policies mention that they do not cover pandemics. Here, claims related to COVID-19 treatment may be rejected. Experts suggest that if one is going to opt for a new policy now, including the COVID-19 treatment, one should look for policies that cover expenses for PPF kits such as masks, gloves, face shields, and shoe covers, sanitizers, and disinfectants which are required for COVID-19.

5. Duration of Hospitalisation:

In many cases, as a policyholder, if you or your loved one has not been hospitalized for more than 24 hours and are discharged due to any reason whatsoever, then the claim might not be accepted.

6. Inaccurate Facts:

This stands true for most claim rejections, similarly in the case of COVID – 19 claims also, any inaccurate information provided by the policyholder will lead to denial of the claim at any point. Misinterpretation of facts also falls under this category of presenting inaccurate facts to the insurance companies.

7. Waiting Period:

The waiting period is allocated depending on the type of policies. The insurer will not consider any claim made during the waiting period and hence the claim will get rejected. The waiting period is mostly allotted for pre-existing diseases. Therefore, if a policyholder has an illness before purchasing the policy, the claim for treating the disease can only be made after the waiting period is over, and the premiums are paid for that tenure.

Therefore, it is best to stay informed before you depend entirely on incomplete or inaccurate information about the many policy covers for COVID – 19. Knowledge and accuracy is what will keep one stress-free during the utmost hours of rush and emergency. However, one should not feel dejected if you fall under any of the above claim rejection categories. It is best recommended to seek guidance in your specific case to keep yourself and your loved ones covered under every circumstance during a health crisis.

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