6 Reasons of Health Claim Rejections (2026)

Health insurance provides a financial safety net during medical emergencies, but what if your health claim gets rejected when you need it the most? 

Do You Know?

A surprising number of claims are rejected every year due to avoidable reasons. According to the Insurance Regulatory and Development Authority of India (IRDAI), 7-8% of health insurance claims are denied annually, often due to missteps by policyholders. 

Top Reasons Why a Health Claim Can Get Rejected

To avoid health claim rejection, it is important to understand the reasons for its rejection, here are some of the most common reasons for the rejection of a health claim by the insurance provider:

1. Non-disclosure of Pre-existing conditions 

On failing to disclose the medical condition you had before, to your insurance provider your claim related to that medical condition could be rejected. Before buying a health insurance policy, it is important to be honest about your medical history to avoid claim rejections in the future. 

Also Read: Benefits of Disclosure of Pre-existing Disease in Health Insurance

2. Waiting Period Not Completed

Most health insurance policies have a waiting period for illnesses, treatments, or pre-existing conditions. If you file a claim within the waiting period, your claim will not be passed.

3. Health Insurance Policy Exclusions 

Some certain medical conditions and treatments are not included under the health insurance policy, like cosmetic surgeries, pre-existing conditions, dental treatments, acupuncture, or homeopathy. If your health claim is for the excluded treatments, it will be denied. It is important to be aware of all the policy exclusions. 

4. Incomplete information or improper documentation 

Filing for a health claim requires detailed paperwork, including hospital bills, doctor’s prescriptions, policy numbers, and medical reports. Even a minor error can lead to rejection of the health claim, such that it is important to double-check all forms and documents ahead of submission

5. Insufficient coverage amount 

In certain cases, there is a possibility of the medical treatment cost exceeding the sum insured under your health policy. The insurance company might not pay the claim in full or could deny it if your medical bills are much more than the policy coverage.  

6. Policy Lapse Due to Non-Payment of Premium

Health insurance is only valid when premiums are paid on time. If your policy has lapsed due to non-payment, any claims during the inactive period will be rejected.

Also Read: How to Make Health Insurance Premium Payment Online

Quick Tips to Avoid Health Claim Rejections: 

In a medical emergency, health claims play a very significant role. Here are some important tips to avoid health claim rejection with an insurer: Understand policy terms and conditions carefully. 

• While buying a health insurance policy, read the terms and conditions carefully. 
• When buying a health insurance policy, be sure to disclose your pre-existing conditions.
• Always provide accurate medical information to the insurer.
• Make premium payments timely
• Timely renewal of the policy. 
• File your claims timely.

Also Read: Guide to File a Reimbursement Claim Under Health Insurance

Summing Up! 

Medical treatments are already overwhelming for anyone, and rejections of a health insurance claim will add to the financial distress. Always be transparent with your insurer, follow the guidelines, and ensure your paperwork is to secure the financial support you need during medical emergencies.