Health Insurance

Insurance is meant to protect you when life takes an unexpected turn — but what happens when your claim gets denied?

At Claimskart, we help you understand your policy, identify the reasons behind a claim rejection, and take the right steps to appeal and recover your rightful insurance benefits.

Here’s a detailed guide to all major types of insurance in India — their purpose, common reasons for denial, and how you can reclaim what’s rightfully yours.

Purpose

Health Insurance covers hospitalization, surgery, and treatment costs arising from illness, accident, or medical emergencies. It prevents your savings from being wiped out by unexpected healthcare expenses.

Get Consultations

Learn more us about insurance

    Common Reasons for Claim Denial

    • Pre-existing illness not declared at the time of purchase
    • Treatment at a non-network hospital (cashless rejected)
    • Delay in claim intimation or missing hospital bills
    • Exclusions like cosmetic, dental, or experimental treatments
    • Disputes in room rent or sub-limit clauses

    How to Overcome Denials & Reclaim

    • Collect all medical and diagnostic documents, prescriptions, and bills
    • Compare treatment details with policy coverage
    • Request claim rejection letter with reasoning
    • Claimskart’s medical claim experts review and prepare an appeal with proper justifications and policy interpretation

    At Claimskart help review and appeal cases where partial settlements or deductions may have resulted from a misinterpretation of policy or regulatory guidelines.

    Representation before Supreme Court

    The Final Step Toward Justice.
    If your matter reaches the Supreme Court of India, we collaborate with Advocates-on-Record and Senior Counsels to represent your case at the highest level.

    • Drafting and filing SLPs
    • Strategic representation before the apex court
    • Continuous coordination and updates

    Representation before National Commission (NCDRC)

    When the Case Reaches the National Stage.
    We represent complex, high-value disputes before the National Consumer Disputes Redressal Commission, ensuring a strategic and evidence-backed approach.

    • Expert preparation of appeals
    • Representation by experienced legal counsel
    • Compliance with NCDRC norms

    Representation before State Commission

    For High-Value or Appeal Cases.
    When your case involves large sums or district-level appeals, our team presents strong legal arguments before the State Consumer Commission.

    • Filing of appeals or original complaints
    • Representation by senior advocates
    • Real-time case tracking

    Representation before Consumer Forum

    Stand Up for Your Rights Before the District Commission.
    If your insurer denies or delays your claim, we represent you before the District Consumer Forum to ensure a fair hearing and resolution.

    • Filing and documentation of complaint
    • Legal representation during proceedings
    • Transparent case updates

    Legal Notice to Insurer

    When It’s Time to Get Serious.
    A well-drafted legal notice can push insurers into action. We issue legally sound notices citing relevant laws, policy clauses, and IRDAI guidelines.

    • Drafted by insurance law experts
    • Sent through registered legal counsel
    • Follow-up and negotiation support

    Ombudsman Representation

    Escalate Your Case to the Insurance Ombudsman.
    If your grievance remains unresolved after 30 days, we escalate it to the Ombudsman. Our team handles the entire complaint process and represents you during hearings.

    • Complaint preparation and annexures
    • Legal representation at hearings
    • Ensuring award compliance

    Grievance Cell Representation

    Make Your Complaint Count — The Right Way.
    We draft and submit formal grievances to your insurer’s redressal cell, ensuring your issue is officially recorded and addressed within IRDAI timelines.

    • Professional grievance drafting
    • Follow-up and response tracking
    • Compliance with IRDAI redressal procedures