Insurance Claim Denied, Here are 10 Reasons!

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The difficulty of dealing with insurance claims is often a scourge for insurance policyholders. Not a few also make it as one of the reluctance to buy an insurance policy whether it’s health insurance, car, or travel insurance. But the difficulty of dealing with such claims is not without reason. Everything is in agreement between the insurer and the buyer of the insurance policy, and is bound by law. That is, claims will not be arbitrarily rejected.

Here are 10 Reasons for Rejecting Your Insurance Claim:

1. Policies Inactive (Lapse)

   The insurance policy may be inactive because of some circumstances. This inactive state is also called lapse. The insurer is not willing to pay insurance claims when the policy is lapse. Here are two examples of the circumstances of the policy being lapse and making your insurance claim rejected.Payment of insurance premium due due to have passed the grace period. Every insurance may have different grace periods. Usually a maximum of about 45 days. If the event occurs after that period, the insurance shall not be liable for any loss suffered by the policyholder, even if 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 in the form of unitlink, the policy can be considered lapse if the cash value of insurance is not enough to cover the cost of insurance. There are at least two causes of inadequate value of this cash, which is not good investment performance and cash value is often disbursed. To avoid it, it’s good to do a top up at a certain time when the investment performance is bad. In addition, make sure not to withdraw cash value, unless at any time in a state of urgency.

2. Claim Not Covered In Clause

   An insurance policy contains an agreement that covers what criteria are entered and is not included in the insurance coverage. In TLO car insurance, what is meant to be heavily damaged can vary from one insurance to another. It could be at least 70%, 75%, even 80%. So, insurance will not cover financing damage, if the damage does not reach an agreed percentage.Let’s take another example. For example, in the policy stroke is a cerebral-vascular attack, permanent neurological, in more than 24 hours. Even if doctors diagnose the policyholder with a stroke but less than 24 hours, the insurance claim can not be filed because it will be rejected.

3. Claim Submission Over Time Specified

   Insurance claims may be delayed or even rejected if the claim management exceeds the time specified in the policy. Insurance always gives a certain time limit for claim management. Through it, claims can be rejected. Car insurance claims should be taken care of immediately because the time limit is short, only 3 x 24 hours. As for insurance such as life insurance, the deadline between 30-60 days.

4. Incomplete Claim Document

   Be sure to know all the documents that must be provided when making a claim. Just one less document, the insurance will refuse the claim. For example for life insurance, a certificate from a doctor is required. You are also required to fill out a claim form.Follow the procedure correctly. If the claim is a car insurance claim, be sure to take photos of the car damage. This photo will be one of the proofs when it comes to filing a claim to the insurance. Next prepare the complete documents, ranging from photocopies of insurance policies, photocopy of driving license and vehicle registration, and of course the claim submission form. A police certificate may also be required in case of serious damage.

   Very filling out the form, fill it honestly and as clearly as the insurance party will do the checking. They will not pay a claim if the contents of the claim form prove to contain lies.

   Another procedure that is not less important is to make improvements in the workshop partner. The same also includes hospital treatment referred by insurance. Must not repair or seek treatment in a place other than insurance referrals.

5. Being Waiting Period

   In certain types of insurance, there is usually a policy called the waiting period. The purchaser of the insurance policy will not be able to claim when it is in the waiting period. For critical illness, there will usually be a waiting period of 30 to 365 days.

6. Disease Has Been Before Insurance Purchased

   The owner of the policy will also be denied his claim when hiding the disease while purchasing a claim. Even if the waiting period has been passed, if the disease has been proven actually experienced since before the purchase of the policy, the insurance will refuse his claim. So, make sure you are still in good health when buying insurance.

7. Insurance Holders Violate the Law

   Another reason that makes insurance claims rejected is when policyholders commit unlawful acts. For example, if he has an all risk car insurance then his car accidents due to inconsiderate or breaking traffic, he can not file a claim. The same is true if the policyholder does not have a driving license while driving, parked anywhere, and get drunk.The holder of the health insurance policy will also not be able to file a claim if for example he suffered severe injuries as a result of mass accusations when committing a crime. The insurance policy is always in compliance with applicable law, so it is impossible to accommodate the things that happen because of violation of law.

8. Include Exceptions Claim

   In addition to arranging for things that include insurance coverage, the policy also regulates exceptions. Exceptions are things that are not covered by insurance coverage. In life insurance, these exceptions include death due to suicide, court punishment, or crime.

9. Perform an Insurance crime

   The definition of insurance crime is an act of lying or sabotage committed intentionally by the policyholder or his heirs so that insurance claims are paid. An insurance policy owner may injure himself, burn his own home, or intentionally cause an accident to get compensation from the insurance. The insurer will automatically refuse the claim if after investigation it is known that the action is intentional. The same is true when heirs commit crimes against the policyholder to get a claim from the insurer.

10. Event Area Excludes Insurance Services

    An insurance policy may also include a territory clause into the deal. Claims are only served when events occur in certain areas only. If a person insures his or her life in Indonesia and the policy states that a claim can only be filed if he dies in Indonesia, the claim will be rejected if he goes abroad and dies there.

Many reasons for rejecting your insurance claims and one of the best ways to find out is to scrutinize, learn, and understand the contents of the policy. Many policyholders disregard this so they end up losing their own mistakes.

Every policyholder must pay close attention to the circumstances that make his or her claim approved. Each definition or explanation in the clause must be correctly understood. It takes time to understand it, because the language used is a legal language that is difficult to understand most people. Nevertheless, learning this will be very meaningful when later on it is necessary to claim.