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| Scheme Name | 1-Year Return | Invest Now | Fund Category | Expense Ratio |
|---|---|---|---|---|
| Axis Nifty 50 Index Fund | +32.80% | Invest Now | Equity: Large Cap | 0.12% |
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| Axis Nifty 500 Index Fund | — | Invest Now | Equity: Flexi Cap | 0.10% |
| Axis Nifty Midcap 50 Index Fund | +46.03% | Invest Now | Equity: Mid Cap | 0.28% |
This study, conducted from June to December 2024, received over 1 lakh responses from policyholders across 327 districts.
The survey also sheds light on the issue of claim delays, with six in ten respondents reporting a wait of six to 48 hours after claim approval before they could secure discharge from hospitals.
Of the 28,700 responses regarding claim settlements, 33% said their claims were only partially paid, while 20% faced outright rejection due to ‘invalid’ reasons.
The Insurance Regulatory and Development Authority of India (IRDAI) also recently reported that 11% of health insurance claims were denied in FY24, totaling ₹26,000 crore in repudiated claims.
This marks a 19.10% increase compared to the previous year.
Here’s a look at possible reasons for insurance claim rejections:
Incorrect documentation or errors in paperwork
One of the top reasons for claim rejection is discrepancies in the policyholder’s documentation.
Whether it’s missing information or errors in medical records, insurers often reject claims if the paperwork doesn’t match their requirements.
This includes errors in diagnosis codes, treatment dates, or even basic policy details.
Non-coverage of pre-existing conditions
Another common reason for claim denial is the non-disclosure or misunderstanding of pre-existing conditions.
Health insurance policies often have clauses that exclude coverage for conditions that existed before the policy was purchased, leading to rejection when claims related to such conditions are filed.
Policy lapses or delayed renewals
If the health insurance policy is not active at the time of claim filing due to non-payment of premiums or failure to renew on time, insurers may reject claims.
This is a critical issue, as many policyholders may not be fully aware of their policy’s renewal status until it’s too late.
Waiting period clause violation
Most health insurance policies come with a waiting period for certain conditions. If a claim is filed for a treatment covered under this waiting period, it may be rejected.
Common treatments affected by this clause include maternity, specific surgeries, and treatment for pre-existing illnesses.
Inadequate treatment or medical records
In some cases, the insurer may find that the medical treatment received doesn’t meet the criteria for reimbursement, or that necessary documentation, such as medical bills and discharge summaries, is incomplete or inadequate.
In these instances, claims are either denied or only partially paid.
