Claim Status Guide
This is how we define the current status of your health insurance claim, depending on where it is in the process:
🔵 1. Received
✅ TPA has received your claim documents and has officially registered the claim in their system.
🟡 2. Under Process
🕓 The claim is under evaluation by the insurer/TPA.
As per IRDAI guidelines, insurers must settle claims within 30 days of receiving the last required document.
If additional documents are requested, the 30-day timeline resets from the submission date of the last document.
📌 Note: In rare cases where an investigation is needed, this timeline can be extended with justification.
🟠 3. On Hold / Deficient
⚠️ Some required documents are missing or incomplete.
Please resubmit the requested documents with your claim number mentioned clearly.
This is essential for processing the claim further.
🟢 4. Processed
✅ The claim has been reviewed and approved. It is now in the settlement stage, and payment is expected in 5–7 working days.
If you need assistance during this stage, feel free to reach out.
🔴 5. Repudiated / Denied
❌ Unfortunately, your claim has been denied by the insurer/TPA.
Possible reasons include:
Sum Insured exhausted
Treatment not covered under policy
Exclusion as per policy terms
🟣 6. Settled
💰 Your claim has been successfully settled and payment has been made.
📅 UTR Number & Date: [Add UTR number & date here]
⚪ 7. Cancelled
🚫 The claim was either:
Wrongly submitted, or
Processed incorrectly and will be re-registered for correction.
We’ll update you with the new claim number once available.
🔵 8. Processed – Document Awaited
🗃️ The claim has been processed, but original hard copies of documents are still awaited to complete settlement.