Insurance policies are filled with fine print, and many people skip reading the details. However, missing key clauses can directly impact claim settlements—sometimes leading to reduced payouts or even outright rejections. Understanding these overlooked conditions ensures you get the coverage you’re paying for.
1. Waiting Periods in Health Insurance
Clause: A waiting period (typically 1–4 years) applies for pre-existing illnesses and specific treatments.
Impact: Claims for these conditions during the waiting period get rejected.
Tip: Check the waiting period duration before buying.
2. Exclusions in Policies
Clause: Policies exclude certain conditions like cosmetic surgery, adventure sports injuries, or war-related damages.
Impact: Claims falling under exclusions won’t be settled.
Tip: Always read the exclusions section carefully.
3. Sub-Limits in Coverage
Clause: Some policies put caps on expenses (e.g., room rent limit of ₹5,000/day in health insurance).
Impact: If you choose a costlier room, you may have to bear a large portion of the bill.
Tip: Opt for policies with higher or no sub-limits if affordability allows.
4. Non-Disclosure of Facts
Clause: You must disclose medical history, smoking habits, or modifications to your car/home.
Impact: Hiding facts can lead to claim rejection for “non-disclosure.”
Tip: Always provide complete and accurate details when buying a policy.
5. Deductibles in Motor & Travel Insurance
Clause: Deductibles mean you share a part of the claim (e.g., first ₹2,000 of car repair cost).
Impact: You may not receive the full amount you expected.
Tip: Understand the deductible amount and choose wisely.
6. Policy Renewal and Grace Periods
Clause: Claims are valid only if the policy is active at the time of the incident.
Impact: A lapsed policy means no settlement, even for genuine claims.
Tip: Renew policies on time and use auto-debit reminders.
FAQs
Q1: Why are claims rejected even after paying premiums on time?
Mostly due to non-disclosure, exclusions, or lapsed policies.
Q2: Can insurers deny claims if details were missed unintentionally?
Yes, insurers rely on full disclosure regardless of intent.
Q3: Do all policies have waiting periods?
Most health insurance plans do, but the duration varies by insurer.
Q4: Can I remove sub-limits?
Some insurers allow it through add-ons or higher premium plans.
Q5: Is reading policy wordings necessary?
Yes, even if long and technical—it prevents surprises at claim time.
Published on : 12th September
Published by : SMITA
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