What happens if my claim is rejected?

Claim rejections can be frustrating, but they are not always final. Here is what to do if your claim is denied or only partially paid.

Common Reasons for Rejection

Claims are most commonly rejected for the following reasons: the condition is classified as a pre-existing condition not yet covered under your waiting period, the treatment is specifically excluded under your plan, the claim was submitted outside the allowed timeframe, or required documentation was incomplete.

What You Should Do

First, request a written explanation from the insurer detailing the reason for rejection. Then contact us at The Insurance Concierge. As your intermediary, we will review the rejection letter, assess whether an appeal is warranted, and if so, submit a formal appeal with the supporting medical documentation on your behalf. Many rejections are successfully reversed at the appeal stage.

Escalation

If the appeal is unsuccessful, we can escalate the matter to the insurer’s complaints team or, where appropriate, to the Financial Industry Disputes Resolution Centre (FIDReC) in Singapore.