One of the most frequent reasons cited by insurers is non-disclosure of pre-existing conditions. If a policyholder forgets to mention prior health issues at the time of policy purchase, the insurer may later use this as a ground to deny the claim. In many cases, however, policyholders are falsely accused of concealment, and we step in legally to defend them.

Delayed submission of claims is another issue. Insurance companies often have strict deadlines for claim intimation and documentation. If the claim is submitted after the stipulated period, it might be rejected even if the treatment was genuine. As a legal practitioner, I help clients establish valid reasons for delay and restore their rights.

Sometimes, the reason for rejection is that the treatment is not covered under the policy. Cosmetic procedures, dental treatments, or alternative therapies may fall under exclusions. However, insurers often misclassify essential treatments and use these exclusions unfairly, which can be legally challenged.

A lapsed policy due to non-payment of premium can lead to claim rejection. However, there are cases where the policyholder was not adequately informed about the lapse. As a consumer and insurance lawyer, I handle such lapses that are a result of poor communication or system errors by the insurer.

Insurers also reject cashless claims citing that the hospital was not in their approved network. In such cases, the insured can still pursue a reimbursement claim. We provide legal support in documenting and defending these claims before the Consumer Commission or Insurance Ombudsman.

Lack of documentation is another frequently used reason. Even when all required papers are submitted, insurers may falsely mark them as missing. We legally compel the insurer to acknowledge submitted records and process claims based on factual evidence.

Pre-authorization failures are common in cashless claims. Hospitals often delay sending pre-auth forms, leading to rejection. Unfortunately, the burden unfairly falls on the policyholder. We help clients navigate these situations and initiate consumer complaints when needed.

Sometimes claims are rejected because the claim amount exceeds the policy limit or room rent cap. While insurers are allowed to impose limits, they are also required to clearly communicate such restrictions at the time of sale. If they fail to do so, it becomes a valid ground for legal action.

Many policies include waiting periods for certain illnesses such as maternity, diabetes, or hernia. Claims raised during this period may be denied. However, if the waiting period or exclusions were not transparently disclosed, we assist clients in filing complaints for unfair denial.

Lastly, insurers may allege fraud or misrepresentation as a reason to deny a claim. These are serious charges and often made without sufficient proof. In such cases, my role as an insurance claim denial lawyer becomes crucial in defending the policyholder with medical and legal evidence.

If your health insurance claim has been denied or delayed unfairly, it is important to act promptly. I represent clients in consumer commissions, and before the Insurance Ombudsman Kochi, ensuring insurers follow IRDAI norms and policy terms. For clients searching for a health insurance claim lawyer, insurance lawyer near me, or a consumer court advocate in Kochi, I offer dedicated and legally sound representation.

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