Will the insurance claim be denied if the documents are not submitted?

K. ARAVIND

There are three things that can happen when you make a claim on a health insurance policy. The insurance company may approve the claim, deny the claim, and proceed with the claim settlement process. These three claims are categorized into three types: claims paid, insured, and pending in the insurance company records. There is also a fourth category. This category is classified as closed claims.

These are claims that have not yet been settled due to the insured person not submitting the required documents. Insurance companies do not include such claims in the list of claims that have been denied. This is because the claim is denied only after examining the nature of the claim and the required documents. At the same time, claims are considered closed claims in cases where the claim application has been submitted but the required documents have not been received or the policyholder has not yet taken appropriate steps in submitting documents for the necessary proceedings.

For example, if a policyholder applies for a cashless claim but is not admitted to the hospital, it will be treated as a closed claim. Or if you apply for a refund after the hospital stay and fails to submit the required documents, it will also fall under the category of closed claims.

Closed claims are classified not only in the case of health insurance but also in the case of other types of insurance. Insurance companies do this to reduce the number of rejected claims.

The claim settlement is based on the ratio of an insurance company to the extent to which it is generous in awarding a claim. It should be noted that if the claim settlement ratio is high, the company will allow a higher rate of claims in proportion to the number of claims received. Closed claims will not be considered when calculating the claim settlement ratio. This helps the insurance companies to increase the ratio. At the same time, not all insurance companies classify as closed claims.

To make a claim, you need to fill up the relevant form and submit it to the insurance company. If the required documents are not submitted along with it, the insurance company will request it. The insurance company usually specifies that the documents must be submitted within the stipulated time. At the same time, a claim cannot be denied simply because the documents were not submitted within the stipulated time. If the reason for the delay in submitting the documents is proved, the insurance company will be ready to settle the claim.