This is when insurers may reject Covid19 health insurance claim
There are multiple reasons relate to the Insurers May Reject Covid19 Claim health insurance claim.
There is a great spurt in claims across the industry owing to the ensuing Covid-19 pandemic
Though insurers have expedite claims and most of these are settle as well.
Due to coronavirus, various insurance policies covering COVID-19 have recently been launch.
Depending on the type of policy.
Policyholders can make insurance claims either through the cashless mode or the reimbursement.
In the latter case, the policyholder needs to pay for the expenses.
Get the expenses reimburse from the insurer by submitting the claim form.
Although there are multiple reasons relate to the rejection of covid19 health insurance policy claims.
Parag Raja, Managing Director and Chief Executive Officer.
Bharti AXA Life Insurance lists out the main reasons why a COVID claim may be disapprove:
In order to keep a policy active, a policyholder needs to pay a timely premium.
Failing to pay premiums on a timely basis leads to a policy lapse.
If death happens in this case then the life insurance company may deny the claim.
Non-disclosure of pre-existing diseases
If the policyholder has a serious pre-existing illness for e.g.
The insured was suffering from cancer prior to policy issuance and the same was not disclose while buying the policy.
Insurers may disapprove to honor the claim.
Many insurance firms have said they are primarily trying and settle all genuine claims.
If an insurance firm has reject a policy claim on unclear grounds, individuals can raise a complaint.
Mild Covid19 Symptoms
In many of the cases where Covid19 insurance claims are being reject.
Insurers said that patients were suffering from mild symptoms and that hospitalization was not needed.
Mild symptoms are cases where the CT value in the RT-PCR report was on the higher side.
However, experts are not happy with such rejections.
On Grounds of Comorbidities
Covid19-specific insurance claims are also being reject on grounds of pre-existing comorbidities.
Which indicate the presence of one or more additional illnesses along with Covid-19 claims.
While Comorbidities are cover under Corona Rakshak policy.
Insurers are rejecting many such claims.
So, in a situation where a patient needs hospitalization due to comorbidities that have been worsen or trigger by Covid-19, insurers are likely to reject the claim.
Insurers are denying such claims on the ground that patients have not been impact directly by Covid-19.
This has also raise concern among insurance experts.
Treatment at Home
While Corona Kavach specifically covers treatment of Covid-19 patients at home.
The purchase of self-help equipment such as pulse oximeter, nebulizer.
Oxygen cylinders, such claims are also being reject by insurance firms.
No concrete reasons are being given for such rejections.
Insurers seem to be dodging such claims due to no hospitalization.
This is contrary to the benefits that have been promise to Covid19-specific insurance policyholders.
Many insurers are also rejecting Covid19-specific claims by citing improper paperwork.
Insurers are now rejecting claims of policyholders as the insured person’s income does not justify his/her income loss of Rs 2.50 lakh.
Which is the sum offer under the Corona Rakshak policy.
Blaming Policyholders for ‘NEGLIGENCE’
Some insurance companies have even blame policyholders for not being careful as they came in contact with Covid-19 patients despite knowing the risk.
Such cases of rejections are mostly emerging where multiple members in a family have got infect.
Such ground for rejection could be challenge as it is impossible for most people in a family to avoid contact until a Covid-19 test has been conduct.
By the time test results come, there are chances that more members in a family have already been infect.
High Volume of Claims
A genuine reason for rejection could be the high volume of claims that insurers are receiving at the moment.
Insurance companies in India have been overwhelm over the past two months due to a high number of claims file by policyholders.
Many insurance firms have said they are struggling to deal with all claims as there were some cases where patients did not require hospitalization but still opted for it.
They also pinpoint cases where patients opted for hospitalization without consulting a doctor.
These are some claims that are being rejected by insurance firms.