Q. Can I challenge a Mediclaim rejection?

A : Yes. If your Mediclaim has been rejected, you have the right to challenge the insurer’s decision.

You can first file a written grievance with the insurance company. If unresolved, you may approach the Insurance Ombudsman, or file a consumer complaint for deficiency in service.

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At Dr. Sunil Khattri & Associates, we analyse your policy, medical documents, and insurer’s reasons to build a strong appeal and represent your case effectively.

 

Q. What if my insurance company delays reimbursement or cashless approval?

A : Under IRDAI guidelines, insurers must process Mediclaim reimbursements and cashless requests within specified timelines. Delays beyond these limits, without valid reasons, are considered deficiency in service under the Consumer Protection Act, 2019.

You are entitled to interest and compensation for unreasonable delays, and we can help you file a legal claim to recover them.

 

Q. Can a Mediclaim be denied because of a “pre-existing condition”?

A : Not always. 

Insurance companies must clearly state exclusions and waiting periods in your policy at the time of purchase. If the insurer did not disclose this properly or is applying the rule unfairly, the rejection can be challenged. 

 

Q. What are my rights if my Mediclaim was rejected on technical grounds?

A : “Technical grounds” like missing documents, claim filed late, or minor procedural errors should not override the substantive medical claim. If your treatment was genuine and medically necessary, the insurer must assess it fairly.

 

Our team frequently helps clients overcome rejections based on such procedural excuses by presenting medical and legal justification in appeals or court.

 

Q. What should I do if the hospital refuses cashless admission?

A : If you are in a network hospital and your cashless request is denied without valid reason, you can:

1. Ask the hospital or TPA for a written explanation.

2. Pay the bill temporarily, keep all documents, and apply for reimbursement later.

3. File a complaint for deficiency in service if the denial was unjustified.

 

We assist in documenting and challenging such cases, ensuring your right to emergency and insured treatment is upheld.

 

Q. What compensation can I seek in a Mediclaim dispute?

A : You can claim:

• The full amount of your unpaid Mediclaim

• Interest on delayed payment

• Compensation for mental agony or harassment

• Legal costs incurred in pursuing your case

 

Consumer courts have granted such reliefs in numerous cases where insurers acted negligently or unfairly.

 

Q. How can Dr. Sunil Khattri & Associates help me?

A : We are domain experts in both medicine and law, bringing over 40 years of combined experience to every case.
Our team:

• Interprets medical records accurately,

• Decodes insurance clauses and exclusions,

• Drafts appeals and complaints effectively, and

• Represents you before Ombudsman, Consumer Courts, or High Courts.

 

We ensure your right to fair Mediclaim settlement is protected from first consultation to final resolution.