Why claims get stuck
- The insurer or TPA keeps asking for more documents.
- The claim has been sent for investigation.
- Billing queries go back and forth between the hospital and the TPA.
- The claim shows “pending” with no update and no one to answer.
The time limits that apply
- Cashless. IRDAI’s 2024 health insurance rules ask insurers to decide a cashless request within 1 hour, and the final discharge authorisation within 3 hours of the hospital’s request.
- Settlement. The insurer must settle or reject a claim within 30 days of receiving the last necessary document. If it investigates the claim, it gets up to 45 days in total.
- Interest. If it pays late, the insurer owes interest at 2% above the bank rate, from the date of the last document until the date of payment.
- Documents. Insurers are expected to ask for all missing documents together, not one at a time.
The clock starts from the date the insurer received your last document, so keep proof of that date: a courier receipt or the email you sent.
What to do, step by step
- Get the status in writing. Email the insurer or TPA with your claim number and ask what is pending.
- Answer requests completely. Send everything asked for in one reply, and ask them to confirm nothing else is needed.
- Track the deadline. Count 30 days, or 45 if the claim is under investigation, from the date of your last document.
- Write to the grievance officer. Once the deadline has passed, ask for settlement with interest and quote the dates.
- Escalate. Register on Bima Bharosa, then go to the Insurance Ombudsman if the insurer still does not act.
How Mediclaimswala helps
We find out exactly where your claim is stuck, send the missing papers in one complete set, and follow up in writing until the insurer settles. If the deadline has passed, we escalate and ask for the interest you are owed.
Last reviewed: . This page is general information based on IRDAI rules as of the date above. It is not legal advice. Policy wordings differ, so we check what applies to your case.