How a rejected claim can be challenged.
Worked examples of common rejections and the rules that can overturn them. These are illustrative examples, not real customer cases: names and amounts are made up. Real stories will appear here once our users share them.
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Illustrative example situations based on common unfair repudiation categories.
Example: Priya (34, Delhi NCR)
Family Caregiver ExampleThe Challenge: Her father's ₹2.4 lakh knee surgery claim was rejected citing 'Pre-Existing Joint Condition' under Clause 4.1. She was stressed, on mobile, and had no legal background.
How MediclaimSaathi Solves It: MediclaimSaathi discovered her father had 52 months of continuous policy renewal. Under the IRDAI 36-month moratorium rule, the insurer could not legally reject. An appeal was prepared in 2 minutes.
Example: Gurdeep Singh (61, Ludhiana)
Senior Policyholder ExampleThe Challenge: Gurdeep received a 6-page English repudiation letter after his cardiac stent procedure. He finds complex online forms hard to navigate and wanted help in Hindi.
How MediclaimSaathi Solves It: He uploaded a photo of the letter and got a plain explanation in simple Hindi, with the deadline for his Ombudsman appeal.
Example: Meena (38, Bengaluru)
Hospital Billing Desk ExampleThe Challenge: Patients frequently dispute hospital billing when claims come back with unexpected 25% to 40% deductions for non-payable consumables and room rent limit capping.
How MediclaimSaathi Solves It: Uses MediclaimSaathi Discharge Check before patient discharge. Identifies room rent proportioning risks and itemized pharmacy disallowances before filing.
Three more common rejections, and the rule that answers each
Illustrative examples. Every claim is different; your own result depends on your policy and documents.
Emergency Hospitalization Delay
Insurer repudiated claim because intimation was sent 5 days after admission instead of 24 hours. The patient was in the ICU.
ICU Parenteral Feeds Disallowance
TPA deducted ₹42,000 for amino acid infusions and enteral bags, classifying them under excluded "diet & food supplements".
Proportionate Deduction on Medicine Bills
Insurer cut 30% across the entire hospital bill (including MRP medicines and implants) because room category was slightly higher.
Want to see what an appeal looks like?
Open a sample dossier built from an example case: case strength, IRDAI rule references and a ready grievance letter.
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Every day you wait brings you closer to the 30-day appeal deadline. Check your letter right now in 90 seconds. We challenge unfair repudiations across Pre-Existing Diseases, ICU room rent caps, Clinical Nutrition disallowances, and Patient Education & Rehabilitation cuts.