Health insurance policy claim checklist: Hospital documentation and other errors that can lead to claim rejections

When Mumbai resident Parth Nagda’s father was hospitalised for heart ailment in 2025, he was not worried about the expenses as his family floater plan covered his parents.

However, his health insurer rejected the claim, citing non-disclosure of preexisting chronic kidney disease. “My father never had kidney-related issues until then. The nephrologist had merely flagged the high creatinine levels (an indicator of kidney function) at the time of admission,” explains Nagda. Only later did he realise that the doctor on duty at the time of discharge had erroneously mentioned ‘chronic kidney disease’ (CKD) in the summary, leading to claim rejection.

“The nephrologist’s notes had only a question mark against ‘CKD’, indicating uncertainty, but the resident doctor labelled it definitively. This led to rejection despite no prior CKD history,” says Mayank Gosar, an insurance consultant who handled Nagda’s case.


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E-mails to the company’s grievance redressal officers, along with a letter of clarification from the nephrologist, yielded no result. Finally, Nagda and Gosar took to social media. “That is when the insurer decided to act and the claim was reopened. However, the insurer requested a notarised letter from the doctor, an unusual demand not normally required. The doctor eventually provided the notarised letter and the claim was cleared,” adds Gosar.

Documentation errors

Like Nagda, Manish Srivastava also suffered due to an incorrect entry in his wife’s discharge summary. “She had a swelling in her knee and fever, for which she was treated at a Delhi hospital. I filed the claim under my corporate policy, and it was paid. However, the hospital recommended further procedures and diagnostic tests, for which we decided to go to Lucknow,” explains Srivastava.

This is where things took a surprising turn. “When I filed a reimbursement claim for the subsequent treatment at the Lucknow hospital, the insurer noticed ‘HTN’ mentioned in the health history, which was part of the Delhi hospital’s discharge summary. It rejected the claim, citing nondisclosure of pre-existing hypertension. She has never suffered from this condition,” says Srivastava.

When hospital errors trigger claim disputes

A wrongly recorded ailment can be treated by insurers as an undisclosed pre-existing disease (PED), leading to claim rejection.

• Errors can creep in when doctors enter health details in discharge summaries.
• Insurers rely heavily on hospital documentation while assessing claims.
• If an ailment not disclosed earlier appears in the records, they may treat it as non-disclosure of PED.
• Patients often do not check discharge summaries carefully because of complex medical jargon.

Mistakes that can affect claims

• Typographical errors.
• Suspected conditions presented as confirmed diagnosis.
• Incorrect PED duration mentioned.
• Non-existent ailment included in medical history.

Resolution pathway

• Approach the hospital immediately.
• Re-submit the claim, along with the certified letter.
• Request a clarification or correction letter from the treating doctor.
• Some insurers might insist on a notarised letter from the doctor acknowledging the error.

Attendant’s to-do list

• Keep a tab on admission notes and initial reports and records.
• Review these to ensure accuracy.
• Do not wait until discharge summary is shared to flag errors, if any.
• Carry complete health records—medical reports, prescriptions and diagnostic test reports.

Final recourse

• Write to the insurer’s grievance redressal department.
• If unresolved, approach the insurance ombudsman.
• As a last resort, consider approaching consumer courts.
• Persistence is the key. Several claims are settled after follow-ups and escalation.

Common occurrences

Despite a letter from the hospital admitting a typographical error, the insurer refused to pay the claim. “It finally paid a part of the claim after a formal letter to the grievance redressal department and multiple follow-ups,” says Shilpa Arora, Co-founder and Chief Operating Officer, Insurance Samadhan, a grievance redressal platform that helped Srivastava with complaint resolution. Such errors occur when doctors on the floor misstate certain details, she says. “They are under pressure, managing multiple tasks simultaneously. We have seen mistakes like the duration of hypertension being listed as six years, instead of two, leading to claim denials,” she adds.

Many others suffer for no fault of theirs, say insurance experts. Patient-policyholders often do not scrutinise their discharge summaries as the medical jargon is not easy to decipher. However, errors can creep in, potentially impacting claim settlement.

“Incorrect entries in medical records are more common than we realise,” says Kapil Mehta, Co-founder, SecureNow, an insurance broking firm. “I have come across a case where the patient was admitted following an injury, but the discharge document mentioned he had had arthritis for a long time,” says Mehta. However, the patient had had only complained of occasional stiffness in hands and legs. “The insurer interpreted this as an undisclosed pre-existing condition and rejected the claim,” he adds.

Hospitalisation checklist

At the time of admission, attendants—and patients, if possible—should be more vigilant. “Doctors create initial records detailing findings during admission. You can seek these copies and review the records to spot errors and ensure timely corrections. An early check is more effective than waiting for discharge summaries, which can be too late or complex to amend,” says Mahavir Chopra, Co-founder, Beshak.org.

It’s best if someone who knows the patient’s medical history shares the details with doctors. “Carrying all the medical files is the best practice. If the patient is able to, (s)he should answer doctors’ questions directly to avoid errors. This reduces risks from memory lapses or inaccurate recounting of medical history,” adds Chopra.

On their part, policyholders must be completely honest about their existing health conditions at the time of purchase. After all, they will have to disclose the history to doctors to ensure optimal treatment. Otherwise, undisclosed health details can come to haunt your claims. “Maintaining accurate and consistent health records helps prevent disputes over pre-existing conditions. If disputes arise despite all efforts at transparency— like doctors’ documentation errors— policyholders must proactively request clarification or provide supporting medical letters to resolve their claims,” says Gosar.

You must be persistent if your claims are rejected due to such errors. “If a mistake has already been recorded, you may have no option but to go back to the hospital and request a clarification letter. There have been instances where doctors have issued written apologies or correction notes acknowledging the error, and such documentation can strengthen your case,” says Mehta. A formal, certified letter from the doctor is a must.

“The claims will then have to be resubmitted, along with the certified letter, to address the reason for rejection. Though the procedure seems straightforward, it depends on timely cooperation from the doctors and hospitals,” says Arora.

Maintain records

You also need to maintain a record of your previous diagnostic reports, which is easy as diagnostic companies’ apps and websites store these details online. “For instance, if a doctor writes that you have been suffering from high blood sugar, but you have test reports showing normal readings, the records can help counter such claims,” adds Mehta.

Perseverance is the key. If the insurer doesn’t respond, escalate the matter to insurance ombudsmen and consumer courts.