Why Do Insurance Claims Get Rejected? Zerodha's Nithin Kamath Explains

Why Do Insurance Claims Get Rejected? Zerodha 's Nithin Kamath Explains

Insurance is the safety net in times of adversity and navigating insurance claims can be complicated, especially when facing rejections. Zerodha CEO Nithin Kamath recently addressed this issue on X (formerly Twitter), urging policyholders to understand their insurance policies better to avoid claim denials.
 

Key Reasons for Claim Rejections:

Kamath highlighted common reasons why claims are denied and provided actionable tips: 

• Waiting Periods: Policies often impose waiting periods for specific illnesses or pre-existing conditions. Reviewing these terms with an advisor before purchasing is crucial.
• Non-Coverage: Some treatments, like those related to drug abuse, are permanently excluded. Understanding these exclusions is essential.
• Fraudulent Claims: Non-disclosure of medical information or pre-existing conditions can lead to rejection. Always disclose all relevant details when applying.
• Blacklisted Hospitals: Claims may be denied if treatment occurs at hospitals not covered by the insurer. Check the hospital list beforehand.
  Unnecessary Hospitalization: Hospitalization for minor ailments, such as fever, may be deemed unnecessary, leading to rejection.
• Delays by Insurers: Claims can be delayed if the insurer conducts additional investigations, affecting cashless treatment approvals.
• Undisclosed Conditions: Suspicions of undisclosed pre-existing conditions can result in claim denials.

Importance of Understanding Policy Terms

Kamath stressed the importance of fully understanding insurance terms, including coverage, exclusions, and pre-existing conditions (PEDs). “Having insurance isn’t enough. Knowing why claims get rejected and how to avoid it is key,” he said.

Seek Expert Guidance

To minimize stress and the chances of rejection, Kamath recommended consulting insurance advisors or legal professionals. A clear understanding of policy terms and professional advice can make the claims process smoother and more successful.