Outlook Money 40After40: Health Insurers Won’t Deny Rightful Claims, Says Tapan Singhel Of Bajaj Allianz

Tapan Singhel, managing director and CEO, Bajaj Allianz General Insurance, spoke on the conditions that policyholders need to meet in order to ensure their insurance claims are not denied. At the third edition of Outlook Money’s 40After40 Retirement event in Mumbai on February 7, 2025, he explained that regulations are something that policyholders should abide by.

Usually, a cashless treatment gets approved in an hour. Additionally, the reimbursement claim gets settled up in 15 days after the submission of documents with the insurer company. If the insurance provider violates this, it will turn into a regulatory violation safeguarding the policyholder, he said. 

“As a customer, you are so empowered. Then the question comes, which are the claims that don’t get paid and why this disconnect is happening,” he said. 

He added that if someone buys a policy after being diagnosed with a major illness, such as cancer or just before undergoing surgery, that claim will not be honoured. If insurance companies started covering such cases immediately, the industry would collapse – people would pay Rs 10,000 and expect Rs 10 lakh in return. That is simply not sustainable, he said. 

He also cautioned against misleading information and false expectations. He said: “If someone tells you an insurance company will always pay, regardless of circumstances, do not fall for it. Companies conduct investigations, and fraudulent cases make up only 2-3 per cent of claims. The remaining 96-97 per cent are processed smoothly,” he said, adding that transparency is the key.  

“If you declare pre-existing (PED) conditions, the company may initially exclude them for 3-5 years, but after that, claims will be honoured. However, if you hide medical history, problems arise,” he said. 

He added that sub-limits are another concern. “If your policy has limits on room rent or doctor fees, the company will only cover costs up to that limit. For instance, if your policy allows Rs 2,000 per day for a hospital room, but you choose one costing Rs 5,000, you must pay the difference. That’s why it’s better to choose a policy without such restrictions,” he added. 

He advised policyholders to go for plans with no limits.  

“Every company offers such policies. They may cost slightly more, but provide better coverage. With rising medical inflation, a comprehensive plan ensures that you are well-protected. The cost falls between Rs 10,000 and Rs 15,000 annually – minimal, compared to potential medical expenses.” 

Singhel also launched ‘HERizon Care’, which is specifically designed to make inclusive health insurance product that caters exclusively to women’s evolving healthcare needs.