Understanding Health Insurance Claim Rejections - A Field-Based Empirical Study in Siliguri

22-05-2026

A Special Empirical Research Work on “From Claim to Rejection: Evaluating the Causes and Patterns of Health Insurance Claim Denials in Siliguri” was conducted by the students of B.A. LL.B (H), Semester VIII ‘A’ under the supervision of Ms. Titas Biswas, Assistant Professor of Law, Indian Institute of Legal Studies, as part of the subject Insurance Law. 

The study aimed to understand the major causes behind health insurance claim denials, including issues relating to incorrect information, incomplete documentation, policy exclusions, non-disclosure of medical history, and waiting period conditions under health insurance policies.

As part of the empirical research, the students visited leading insurance companies in Siliguri, including Star Health and Allied Insurance, Niva Bupa Health Insurance, and Aditya Birla Health Insurance Company Limited, to gain practical insights into the claim settlement process and the reasons behind claim rejections.

 During the visits, the students interacted with insurance agents and company officials who explained the procedures involved in claim processing and informed the researchers that a significant percentage of genuine claims are generally accepted, while denials primarily arise due to concealment of material facts, submission of incomplete documents, and claims falling outside policy terms and conditions. 

One of the most interactive sessions was conducted at Aditya Birla Health Insurance Company Limited, where Branch Manager Mr. Shankar Chakraborty organised an informative seminar-style discussion providing valuable practical understanding of health insurance policies and claim settlement mechanisms. The study highlights the importance of consumer awareness, transparency, and compliance with policy conditions in reducing claim disputes and ensuring effective insurance protection.

Students Involved:
• Kumari Mamta
• Shekh Mampi
• Khushi Ranjan
• Protima Biswas
• Sayan Bose
• Supratim Roy