Insurers may Reject Your COVID-19 Claim Policy: Here's Why?

covid-19 policy claim rejection

You purchase health coverage to help shield yourself from unexpected monetary requirements related to hospitalization. The cashless claim guarantees that all medical expenses are covered by the insurance agency from the beginning. Except for a meager amount, you do not have to break the bank in the hospital. However, the covid scaling cases have caused an unprecedented period of deaths, turmoil, anxiety, and fear.

COVID-19 claims are deluging private insurers. Sometimes even if your policy qualifies for cashless resolution, healthcare providers would inhibit your claim by giving some other excuses. It culminates into a situation wherein you have to pay the entire amount yourself and then file for compensation later for your medical expenses incurred during your stay in the hospitals and medical centers in Kolkata.

Firstly, let’s understand under what grounds would you be able to avail for just any health insurance:-

  • The hospitalization must be sanctioned by a medical practitioner
  • It should follow standard treatment guidelines.
  • There should be an operational line of medication that can only be conducted in a hospital.

Coming back to our topic at hand, there are various ways or loopholes through which the insurers may deny or put limits on your Covid-19 insurance claim policy. Here are the reasons-

Documentation Issue

Several hospitals, according to insurance providers, seem unable to present sufficient documents and instead deliver only the patient's covid-19 positive report for insurers to litigate the requests. More confusion and queries are stemming due to this reason. The insurance agent must assess the severity of the medical situation to determine whether or not the patient meets the prerequisites of hospital admission. They are following AIIMS, government, WHO, and ICMR standards to classify the disease's intensity and duration and determine the necessity for hospitalization or home quarantine. As a result, each claim form must include adequate bills, discharge overview, diagnostic reports, and doctor's treatments. According to defined standards, if no clear evidence for hospitalization is detected, the claim may be denied.

Non-Disclosure of Diseases

If the patient has co-morbidities such as kidney disease and/or diabetes for a month or more and fails to provide accurate evidence at the point of purchase of the covid policy insurance, the claim may be refused. However, insurers usually discover these inconsistencies when it's too late, so ensure a doctor’s consultation in Kolkata before making a hasty decision. 

Waiting Period

Be it a covid-specific practice or just any health policy, there would always be a waiting period. Any claim made in an active waiting period would be deemed inconsiderable by the healthcare agency. The ensuing waiting period for covid-specific proposed policies is typically 15 days. In contrast, routine medical regulations can be approximately for 30 days, four years for pre-existing diseases, and one or two years for chronic patients, and the list goes on.

Domiciliary Hospitalization

Domiciliary Hospitalization focuses on treating any illness/disease/injury that, in the natural course of events, would necessarily imply diagnosis and services in a hospital but is instead received while restricted at home. So, obtaining domiciliary hospitalization without first attaining prior approval from an insurer may also result in claim denial. There are specific health plans and Corona cover-based policies that provide provisions for domiciliary treatment. However, in such a scenario, it becomes necessary to seek pre-approval from the agency itself.


With this piece of information, you are now cognizant of the rapidly evolving changes of the covid-19 claim policies. This will ensure your security and safety in the long run. In such dire times, you need all the help you can get. No matter the problem, be it the requirement of the 24-hour ambulance service in Kolkata or online covid consultation with experts, you can always search for the requisites in any one-stop business listing portals in India.

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