Insurance Claim Rejected, Here Are 10 Reasons

Insurance Claim Rejected, Here Are 10 Reasons. The difficulty of managing insurance claims is often a scourge for insurance policyholders. Not a few also make this as one of the reluctance to buy an insurance policy, be it health insurance, car, or travel insurance. However, the difficulty of managing these claims is not without reason. Everything is in the agreement between the insurer and the buyer of the insurance policy and is legally bound. That is, the claim will not be arbitrarily rejected.

Here are the reasons your insurance claim was rejected:

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1. Policy Is Inactive (Lapse)

Insurance policies can be in an inactive state due to several circumstances. This inactive state is also known as a lapse. The insurer is not willing to pay insurance claims if the policy lapses. Here are two examples of a policy situation being lapsed and making your insurance claim rejected.

Payment of insurance premiums is due because the grace period has passed. Each insurance may have a different grace period. Usually a maximum of about 45 days. If the incident occurs after that period, the insurance will not be responsible for any loss suffered by the policyholder, even if it is included in the policy clause. Pay insurance premiums on time or at least not until the end of the grace period.

If the insurance policy is in the form of a unit link, the policy can be considered a lapse if the cash value of the insurance is not sufficient to cover insurance costs. There are at least two causes for this insufficient cash value, namely poor investment performance and frequent cash disbursements. To avoid this, it’s a good idea to top up at a certain time when investment performance is bad. In addition, make sure not to withdraw the cash value, unless at any time in a state of urgency.

2. Claims Not Covered in the Clause

Insurance Claim Rejected
Insurance Claim Rejected

The insurance policy contains an agreement that includes what criteria are included and not included in the insurance coverage. In TLO car insurance, what is meant by seriously damaged may vary from one insurance to another? It could be at least 70%, 75%, or even 80%. So, the insurance will not cover the cost of damage, if the damage does not reach the agreed percentage.

Let’s take another example. For example, the policy states that a stroke is a cerebral-vascular attack, permanent neurological, lasting more than 24 hours. Even if the doctor diagnoses the policyholder as having a stroke but it is still less than 24 hours, the insurance claim cannot be submitted because it will be rejected.

3. Submission of Claims Exceeded the Time Specified

Insurance claims can be delayed or even rejected if the claim processing exceeds the time specified in the policy. Insurance always provides a certain time limit for processing claims. After that, the claim can be rejected. Car insurance claims must be taken care of immediately because the deadline is short, only 3 x 24 hours. Meanwhile, for insurance such as life insurance, the time limit is between 30-60 days.

4. Incomplete Claim Documents

Make sure you know all the documents that must be provided when you want to make a claim. If one document is missing, the insurance will reject the claim. For example, for life insurance, a doctor’s certificate is required. You are also required to fill out a claim form.

Follow the procedure properly. If the claim submitted is a car insurance claim, be sure to take photos of the damage to the car. This photo will be one of the proofs when you want to submit an insurance claim.

Next, prepare complete documents, starting from a photocopy of the insurance policy, a photocopy of your driver’s license and vehicle registration, and of course the claim submission form. A certificate from the police may also be required in case of serious damage.

Very fill out the form, fill it honestly and as clearly as possible because the insurance will later check. They will not pay the claim if the contents of the claim form are proven to contain lies.

Another procedure that is no less important is to carry out repairs at the partner’s workshop. The same thing also includes treatment at a hospital referred by insurance. May not repair or seek treatment in a place other than insurance referrals.

5. Being in the Waiting Period

In certain types of insurance, there is usually a policy called a waiting period. Buyers of insurance policies will not be able to submit claims while they are in the waiting period. For the critically ill, there will usually be a waiting period of about 30 to 365 days.

Let’s say the waiting period is about 30 days. The insurance policy was purchased on February 1, 2015. Then he became critically ill on March 1, 2015. If he submits a claim, the insurance will reject it, because it has not passed the waiting period.

6. Diseases Existed Before the Policy Was Purchased

The policy owner will also have his claim rejected if he hides his illness when buying a claim. Even though the waiting period has If it is proven that the disease that has arisen has been experienced before the purchase of the policy, the insurance will reject the claim. So, make sure you are still in good health when buying insurance.

7. Submission Claims Include Exceptions

In addition to regulating things that are included in insurance coverage, the policy also regulates exceptions. These exceptions are things that are not covered by insurance. In life insurance, these exceptions include death by suicide, court sentences, or crimes.

In car insurance, the exceptions that make the claim rejected include vehicles that are not used according to their designation or are modified without notifying the insurance company. An example of a vehicle that is not functioned according to its designation is using a motorcycle to transport goods that exceed its capacity.

As for the case of motor vehicle modifications, make sure to always notify the insurance and make sure that modifications are indeed allowed. Do not make non-standard modifications that cause accidents. If this is the case, the insurance will not be willing to cover the repair costs.

8. Policyholders Break the Law

Another reason that makes an insurance claim is rejected is when the policyholder commits an unlawful act. For example, if he has all-risk car insurance and then his car is in an accident due to recklessness or traffic violations, he cannot file a claim. The same is true if the policyholder does not have a driver’s license when driving, parks in any place, and is drunk.

The holder of a health insurance policy will also not be able to file a claim if for example he is seriously injured as a result of being beaten by a mob while committing a crime. Insurance policies always comply with applicable laws, so it is impossible to accommodate things that occur due to violations of the law.

9. Committing Insurance Crimes

What is meant by insurance crime is an act of deceit or sabotage that is intentionally carried out by the policy owner or his heirs so that insurance claims are paid. An insurance policy owner may injure himself, set fire to his own house, or intentionally cause an accident to get compensation from insurance.

The insurer will automatically reject the claim if after investigation it is known that the action was intentional. The same is true if the heir commits a crime against the policy owner to get a claim from insurance.

10. Event Area Does Not Include Insurance Service

An insurance policy may also include a territory clause in the agreement. Claims are only served if the incident occurs in certain areas. If a person insures his life in Indonesia and the policy states that a claim can only be submitted if he dies in Indonesia, it means that the claim will be rejected if he goes for treatment abroad and dies there.

11. Limit Exceeded

Everyone agrees that the customer is king. Even so, each customer cannot make their own decisions arbitrarily, because customers must also follow the provisions or regulations that have been imposed on financial institutions, including insurance.

Each insurance company determines the maximum claim value that can be disbursed. If the customer often makes claims, the limit will run out. For subsequent claims, the insurance company will refuse.

12. The Company Doesn’t Guarantee Insurance Anymore

Each company cooperates with insurance to serve as permanent employee benefits. This insurance is valid as long as the employee works at the company. When the employee has resigned from the company, the employee can no longer claim the insurance previously provided by the company.

13. Claims Outside the List of Specified Partners


Claims outside the specified list

If you submit a cashless claim on insurance, then you cannot claim the insurance outside the specified list of partners. You can only claim insurance from partners who have collaborated with the insurance you choose.

Watch Well

There are many reasons why your insurance claim is denied and one of the best ways to find out is to examine, study, and understand the contents of the policy. Many policyholders ignore this and end up losing money because of their own mistakes.

Every policy owner must pay close attention to any circumstances that make his claim approved or not. Every definition and explanation in the clause must be understood correctly. It does take time to understand it because the language used is a legal language that is difficult for most people to understand. However, learning this would be very meaningful the next time he needed to

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