Claim Reject - Zyadatar Baar Company Ne Dhokha Nahi Diya Hota, Form Bharte Waqt Ek Baat Chhupa Di Gayi Hoti Hai
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Overview
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Insurance Claim Reject Kyun Hota Hai
Bhaiyon aur behno, jab claim reject hota hai to pehli baat yahi kahi jaati hai - "company ne dhokha kar diya". Kabhi-kabhi ye sach hota hai. Par imaandaari se:
Zyadatar claim isliye reject hote hain kyunki form bharte waqt koi baat chhupa di gayi thi, ya suchna der se di gayi, ya wo cheez policy me thi hi nahi.
Achhi khabar ye hai ki ye teenon galtiyan pehle se roki ja sakti hain - aur reject hone ke baad bhi rasta khatam nahi hota.
Sabse Aam Wajahein
1. Purani beemari ya sach chhupana. Ye sabse badi wajah hai. Form me BP, sugar, purana operation ya sharaab/tambaku ki aadat chhupa dena - claim ke waqt aspatal ke record se sab saamne aa jaata hai, aur poora claim rad ho jaata hai.
2. Waiting period poora na hona. Pehle se maujood beemari ka cover turant shuru nahi hota. Kai log policy lekar agle hi mahine bade ilaaj ka claim karte hain, aur wo nahi milta.
3. Der se suchna dena. Har policy me suchna dene ki ek avadhi hoti hai - motor me haadse ke baad, health me bharti hone par. Der karne pe claim kamzor pad jaata hai.
4. Wo cheez policy me thi hi nahi. Har policy me kuch cheezein bahar (exclusions) hoti hain. Ye brochure ke aakhir me chhoti likhi hoti hain aur koi nahi padhta.
5. Kaagaz adhoore hona. Bill, discharge summary, jaanch ki report, FIR (jahan zaroori ho) - ek kaagaz kam hone par file rukti rehti hai.
6. Policy hi lapsed hona. Premium nikal gaya aur renew nahi kiya - us halat me cover hai hi nahi.
7. Galat vyakti ya galat halat. Jaise bina valid licence ke gaadi chalana, ya jis kaam ke liye policy nahi thi.
Cashless Aur Reimbursement - Fark Samajh Lo
Ye do alag raaste hain aur donon ka tarika alag hai:
| Cashless | Reimbursement | |
|---|---|---|
| Kahan | Sirf network aspatal me | Kisi bhi aspatal me |
| Paisa | Company seedha aspatal ko | Aap pehle dete ho, phir wapas milta hai |
| Pehle karna kya hai | Pehle se manzoori lena | Kaagaz sambhal kar rakhna |
| Sabse aam galti | Bina manzoori bharti ho jaana | Bill aur report gum kar dena |
Cashless me aksar mana isliye ho jaata hai ki manzoori ke waqt di gayi jaankari aur aspatal ke record me fark nikal aata hai.
Aur ek baat: cashless me bhi aapka apna hissa (co-pay) aur wo cheezein jo policy me nahi hain aapko hi deni hoti hain.
Claim Ke Waqt - Ye Kram Follow Karo
1. Company ko turant batao. Bharti hone par ya haadse ke baad - phone ya app se, aur suchna ka number/reference likh lo.
2. Har kaagaz sambhalo. Bill, discharge summary, saari jaanch report, doctor ki parchi. Original sambhal kar rakho.
3. Jahan zaroori ho, FIR karao. Chori aur bade haadse me ye anivarya hota hai.
4. Form khud padh kar bharo. Kisi aur ko bharne do to bhi khud padh kar hi sign karo.
5. Har baat likhit me. Zubani jawab ka koi record nahi banta.
Reject Ho Jaye To - Rasta Yahan Se Shuru Hota Hai
Yahan zyadatar log haar maan jaate hain, aur wahi galti hai.
Charan 1 - Likhit me kaaran maango. Company ko likhit me batana hota hai ki claim kis aadhaar par mana kiya gaya. Ye aapka haq hai. Bina kaaran jaane aage nahi bad sakte.
Charan 2 - Company ki apni shikayat shakha (grievance cell). Har bima company me shikayat nivaran ki apni vyavastha hoti hai. Wahan likhit shikayat do aur prapti lo.
Charan 3 - Bima niyamak ki shikayat vyavastha. Company se santushti na mile to niyamak ki shikayat prakriya ka istemal karo.
Charan 4 - Bima Lokpal (Insurance Ombudsman). Ye ek nishulk vyavastha hai jo policy dharak aur company ke beech vivad sunti hai. Iske liye vakeel ki zaroorat nahi hoti.
Do zaroori baatein:
- Har charan ki samay seema hoti hai - der mat karo
- Aage badhne se pehle pichhle charan ka jawab ya uska intezaar poora hona chahiye
Sabse Achhi Suraksha - Policy Lene Ke Din
Reject hone ke baad ladne se behtar hai ki wo nautbat aaye hi na. Teen aadat:
1. Form me sab kuch sach likhwao. Beemari batane par premium thoda badh sakta hai, par policy chalegi. Aur yahi poora maksad hai.
2. Exclusions ka panna zaroor padho. Us ek panne me likha hota hai ki kya nahi milega.
3. Waiting period aur co-pay lene se pehle poochho. Ye do sawaal aadha jhagda pehle hi khatam kar dete hain.
Motor aur health ke apne-apne niyam yahan hain: Bike Insurance, Car Insurance, Health Insurance, aur maa-baap ke liye: Parents Health Insurance.
Scam Se Bacho
"Claim pass karwa denge, commission do" - FRAUD. Claim prakriya se pass hota hai; shikayat ka rasta nishulk hai.
"Bill badhwa lo, zyada mil jayega" - ye bima dhokhadhadi hai. Pakde jaane par claim to jaata hi hai, aage aur mushkil hoti hai.
"Aapka claim atka hai, verification fee bhejo" - bima ka paisa lene ke liye kabhi pehle paisa nahi dena hota.
"Purani policy band karo, nayi me claim mil jayega" - purane claim ka nayi policy se koi lena-dena nahi.
Thagi ho jaye to cybercrime.gov.in | 1930
FAQs
Q: Insurance claim sabse zyada kis wajah se reject hota hai? A: Form bharte waqt purani beemari ya sach chhupana - claim ke waqt aspatal ke record se wo saamne aa jaata hai.
Q: Kya der se suchna dene par claim reject ho sakta hai? A: Haan - har policy me suchna dene ki avadhi hoti hai; der karne par claim kamzor pad jaata hai.
Q: Cashless aur reimbursement me kya fark hai? A: Cashless network aspatal me hota hai aur usme pehle se manzoori leni padti hai; reimbursement me aap pehle bhugtaan karte ho aur baad me wapas milta hai.
Q: Cashless me bhi paisa dena padta hai? A: Haan - co-pay aur wo cheezein jo policy me nahi hain, aapko hi deni hoti hain.
Q: Claim reject hone par pehla kadam kya hai? A: Company se likhit me kaaran maango - wo aapka haq hai aur uske bina aage nahi bad sakte.
Q: Bima Lokpal kya hai? A: Policy dharak aur bima company ke beech vivad sunne wali nishulk vyavastha - usme vakeel ki zaroorat nahi hoti.
Q: Shikayat me kitna kharch aata hai? A: Shikayat ki prakriya nishulk hai. Koi "fees" maange to wo thagi hai.
Q: Reject hone se kaise bachein? A: Form me sab sach likhwao, exclusions ka panna padho, aur waiting period evam co-pay pehle poochho.
Ye Bhi Zaroor Padhein
- Health Insurance Kaise Le - lete waqt kya dekhein
- Parents Health Insurance - buzurgon ke liye alag niyam
- Bike Insurance Kaise Le - motor claim ki shartein
- Car Insurance Kaise Le - cashless ka asli matlab
- Term Insurance Kya Hai - claim ratio kyun dekha jaata hai
- LIC Policy Surrender - policy band karne ka rasta
Source: is page me kisi bima company ka naam, claim ka aankda, samay seema ya kisi vishisht policy ki shart jaan-boojh kar nahi di gayi - suchna ki avadhi, prateeksha avadhi, co-pay evam exclusions har policy ke apne dastavez me tay hote hain. Yahan jo wajahein aur prakriya batayi gayi hai wo bima daave ki aam vyavastha par aadharit hai: daava aam taur par tathya chhupane (non-disclosure), prateeksha avadhi poori na hone, nirdhaarit samay me suchna na dene, policy se bahar (exclusion) ki cheez hone, dastavez adhoore hone ya policy lapsed hone ke aadhaar par asveekrit hota hai. Asveekriti ka likhit kaaran maangna policy dharak ka adhikaar hai, aur uske baad bima company ki shikayat nivaran vyavastha, niyamak ki shikayat prakriya evam Bima Lokpal (Insurance Ombudsman) tak rasta khula rehta hai - jo policy dharak ke liye nishulk hai. Apni policy ki shartein, samay seema aur shikayat ka asli tarika hamesha apne policy dastavez evam bima company se hi pakka karein.
Bhaiyon aur behno, ek baat jo dukh ke saath kehni hai. Sabse zyada claim un logon ke reject hote hain jinhone agent ke kehne par form me sach nahi likha - "ye mat likhwao, premium badh jayega". Us din wo salah sasti lagti hai. Aur jis din aspatal me bill saamne hota hai, us din wo sabse mehngi sabit hoti hai. Policy ka kaam mushkil ke din khada hona hai, aur wo tabhi khadi hogi jab uski neenv sach par rakhi ho.
Page Last Updated: 10 August 2026
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