One Step Cloud Solutions - Rejected Claim Reopen

One Step Cloud Solutions

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What are some common examples of insurance mis-selling?
You can be sold an insurance policy wrongfully in many ways. Let us take a look at some of them:

· Promising interest-free loan on a mortgage or insurance plan.

· The promise of free health insurance.

· Insurance sold as a Fixed deposit in a bank.

2. Why do insurance companies reject claims?

There are many reasons why your insurance claim can get rejected, such as a delay in Health Claim Reimbursement, insurance policy exclusions, PED not disclosed, etc. It is important to avoid any such insurance claim rejection scenarios.

3. Can an insurance claim be delayed due to pre-existing conditions?

A claim can be delayed due to pre-existing conditions, especially if the insurance company needs to review the policyholder's medical history or obtain additional information from the healthcare provider.

4. Can a short-settled claim be re-submitted for payment?

Yes, a short-settled claim may be re-submitted for payment.

5. How do I check for errors and Inconsistencies in my/family member's policy document?

Access the 'Know Your Policy' feature on our mobile application "Polifyx" to upload your complete policy document and identify any errors or inconsistencies that could result in claim rejections or delays in the future.

6. How do we handle your case?

We help you represent your case with the Insurance Company, Insurance Ombudsman (Bima Lokpal), and consumer court depending on the case.

7. How can I track the status of my insurance complaint?

Once your case is accepted and registered, you can get real-time case updates on Polifyx App.

8. Is there any fee to register with us?

A one-time registration fee of INR 999, including GST, is applicable for all life, health, and general policies for you and your family members after case acceptance.

9. What is a success fee?

Once we successfully resolve your insurance complaint, we charge a success fee of 15% of the amount received (plus GST).

10. How long will it take to resolve my insurance-related problem?

Any insurance-related matter problem totally depends on the case. So, it is advisable to be patient.

11. What is the pre and post hospitalization claim?

Generally expenses 30 days before the hospitalization and 60-90 days post discharge from the hospital are covered in the medical policy. We help apply your reimbursement at a nominal cost of INR 799 taking away the hassles of filling and submitting the claim forms.

12. Does smoking affect insurance plans?

It is essential to disclose your smoking or alcohol consumption habits while purchasing insurance as it would be unethical to withhold this information and may result in claim rejection.

13. Is there a waiting period before filing a claim under a health insurance policy?

Typically, there's a waiting period of 30 days from the insurance policy's start date.

14.What should I do if I am admitted to a hospital that is not in your network?

If admitted to a hospital outside your network, you would typically need to pay the bills upfront and seek reimbursement from your insurance company afterward.

15. What is insurance mis-selling policy?

Mis-selling of insurance policies refers to when an agent or intermediary purposefully sells a client an insurance policy that is not what it is, is not fully explained to them, or is offered to them outside their intended target market.

16. How can an insurance policy be mis-sold?

There are many ways by which an insurance policy can be mis-sold to you. Some examples are: