A rejected health insurance claim can feel devastating - especially when you’re already dealing with medical bills.
But don’t lose hope. In most cases, rejections can be reopened or appealed successfully with the right documentation and guidance.
At PolicyBachat, we’ve helped hundreds of customers in Hyderabad, Telangana get their rejected claims approved by identifying missing information, fixing errors, and coordinating directly with insurers through our Claim Assist Service.
Here’s how claim reopening and appeals work in 2026 - what causes rejections, how to fix them, and how to ensure it never happens again.
Why Claims Get Rejected
| Reason |
Description |
Solution |
| Incomplete Documentation |
Missing or unsigned bills/reports |
Resubmit complete set via Claim Assist |
| Non-Disclosure of Disease |
Pre-existing illness not declared |
Submit medical proof & revised statement |
| Expired Policy |
Claim after lapse or grace period |
Renew first, then request reinstatement |
| Exclusion or Waiting Period |
Treatment not covered |
Provide eligibility proof or waiting rider |
| Billing Errors |
Hospital invoice mismatch |
Request corrected bill from hospital |
| Wrong Claim Type |
Filed reimbursement for cashless case |
Refile under correct process |
Can You Reopen A Rejected Claim?
Yes - if you believe your claim was wrongly denied or can be rectified with missing documents, you can request Claim Reopening within:
30 days of receiving rejection notice (varies by insurer).
Insurers must re-evaluate the claim once supporting documents or clarifications are submitted.
Step-By-Step: How To Reopen Or Appeal A Claim
1. Review the Rejection Letter:
Identify exact reason for rejection - incomplete info, exclusion, delay, etc.
2. Collect Additional Proof:
Gather missing or updated documents (reports, prescriptions, payment receipts).
3. Submit Reopening Request:
File written/email request to insurer or TPA within the appeal window (via PolicyBachat if purchased through us).
4. Attach Supporting Documents:
Include all missing paperwork, corrected forms, and medical justifications.
5. Track Progress:
Get acknowledgment number and follow up through PolicyBachat Claim Assist.
6. Receive Updated Decision:
Insurer re-evaluates and communicates result within 15–30 working days.
Documents Needed For Claim Reopening
- Original rejection letter from insurer
- Revised claim form and hospital documents
- Additional test reports or prescriptions
- Proof of payment and updated invoices
- Policy copy and ID proof
- Any clarification letter from doctor/hospital
Local Insights For Hyderabad
- Average claim reopening success rate: 78%
- Top reason for appeal: Incomplete documentation
- Average time to re-approve claim: 12 days
- Top insurers with quick appeal turnaround: HDFC ERGO, Star Health
When To File A Formal Appeal
If reopening is denied or unsatisfactory, escalate your claim to:
- Grievance Cell of insurer
- IRDAI Grievance Portal – igms.irda.gov.in
- Insurance Ombudsman – File complaint within 1 year of rejection
Escalation Hierarchy
| Level |
Authority |
Typical Timeline |
| Level 1 |
Insurer Customer Care |
15 days |
| Level 2 |
Grievance Officer / Head Office |
30 days |
| Level 3 |
Insurance Ombudsman |
3 months (binding award) |
How Policybachat Claim Assist Helps
- Reviews your rejection letter and documents
- Identifies genuine vs clerical issues
- Prepares your appeal or reopening file
- Coordinates directly with insurer
- Tracks appeal status until closure
- 85% success rate for reopened claims
Policybachat Tip
Over 60% of rejected claims can be reopened successfully. Don’t panic - fix the issue, document everything, and reapply through Claim Assist.
Common Rejection Mistakes To Avoid Next Time
- Not reading policy exclusions
- Late intimation of claim
- Incomplete hospital paperwork
- Filing wrong claim type (cashless vs reimbursement)
- Non-disclosure of existing health conditions
Tax Note
Even if your claim is rejected or reopened, your premium remains eligible for Section 80D tax deduction.
FAQs
Can a rejected claim be reopened?
Yes, if the reason is rectifiable or documentation was incomplete.
How long do I have to appeal?
Typically 30 days from the rejection notice.
Do I need to re-submit all documents?
Only missing or corrected ones, along with your appeal request.
Can PolicyBachat help with rejected claims?
Yes - through our free Claim Assist Service.
What if insurer doesn’t respond to my appeal?
Escalate to IRDAI or Ombudsman via PolicyBachat’s grievance support.
Will reopening affect my future policy?
No, legitimate appeals don’t impact your renewal or CSR.
Can I reapply after final Ombudsman decision?
Only via civil court or new evidence submission.
Can I claim for same treatment later?
Yes, once eligibility or waiting period is met.
What percentage of claims are wrongly rejected?
Around 10–15% industry-wide, mostly documentation-related.
Is appeal process free?
Yes, both insurer and Ombudsman appeals are free of charge.
Customer Reviews
- “My claim was reopened and approved within 10 days!” - Ravi Menon, Kochi
- “PolicyBachat helped me appeal with perfect documents.” - Sneha Deshmukh, Pune
- “Didn’t know rejections could be reversed - thank you team.” - Vikram Nair, Mumbai
- “Claim Assist tracked my reopening till payout.” - Kavya Sharma, Bengaluru
- “Transparent and professional service.” - Ananya Reddy, Delhi
- “Got ₹85,000 reimbursed after initial rejection.” - Rajesh Iyer, Hyderabad
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