Health Insurance Claim Rejections in India: IRDAI Report FY 2023–24

A Wake-Up Call for Policyholders

According to the Insurance Regulatory and Development Authority of India (IRDAI) annual report for FY 2023–24, health insurance claim rejections have seen a significant rise. The data highlights growing concerns for policyholders who may face delays, deductions, or outright denial of their claims.

Key Data from IRDAI:

• ₹15,100 crore worth of claims were disallowed (12.9% of total claims)

• ₹10,937 crore worth of claims were repudiated (completely rejected)

• ₹7,584 crore remain outstanding (unsettled or under process)

This means a large chunk of claims in India either go unpaid or are delayed—creating stress for families during medical emergencies.

Common Reasons for Health Insurance Claim Rejections

Understanding the common causes can help prevent them.

1. Incomplete Documentation
Claims are often rejected due to missing hospital bills, prescriptions, ID proofs, or pre-authorization forms.
Tip: Submit all required documents clearly and promptly.

2. Non-Disclosure of Pre-Existing Conditions
Hiding conditions like diabetes or high blood pressure can result in claim denial.
Tip: Always disclose your full medical history when buying a policy.

3. Policy Exclusions
Claims for treatments not covered under your plan—like dental care or surgeries during the waiting period—get rejected.
Tip: Read your policy document carefully or ask an expert for help.

4. Delay in Claim Filing
Most policies require claims to be submitted within 30 days. Late submissions can be disqualified.
Tip: Start the claim process as soon as hospitalization occurs.

5. Claim Amount Discrepancies
Overestimating or incorrectly reporting treatment costs can cause rejections.
Tip: Match your bills to the actual costs and stay within the sum insured.

How FairClaimSolutions Helps You

FairClaimSolutions is here to support you through difficult claim situations. We help with:

• End-to-end claim filing

• Documentation and paperwork

• Rejected claim appeals

• IRDAI complaint support

• Direct coordination with insurers

If your claim has been rejected or delayed — we’re here to help.
Contact us on WhatsApp

Conclusion

The IRDAI’s latest data shows that insurance claim rejection is more common than most expect. But with the right awareness and expert help, your claim has a much better chance of being approved.

Let FairClaimSolutions guide you in protecting your financial rights during medical emergencies.