Claim stories
Real patterns behind denied and delayed claims
Anonymised case studies drawn from real complaints, with a Solvh analysis of what went wrong and how it was escalated.
Health insurance
Cashless Health Claim Rejected Five Times for Abdominal Emergency Despite Clear Imaging Evidence
A policyholder's brother was admitted for an abdominal emergency and had his cashless claim rejected five times with a different verbal reason each time, despite ultrasound and CT findings clearly supporting the admission.
Health insurance
Health Claim Rejected Over Hospital Billing Format: A Policyholder's Fight for Fairness
A policyholder's genuine hospitalisation claim was rejected because the insurer flagged the hospital's invoice numbering sequence and absence of a GST number on bills, despite full submission of medical records and a doctor's clarification letter.
Health insurance
Health Claim Rejected for "Hospitalisation Criteria Not Met" Without a Policy Clause Cited
A policyholder's health claim was rejected on vague hospitalisation-criteria grounds, with no specific policy clause or exclusion provided to justify the decision, despite the policy carrying OPD coverage.
Health insurance
Health Claim Denied Because Hospital Was on Insurer's Excluded List: A Policyholder's Fight for Transparency
A policyholder's health insurance claim was rejected because the treating hospital appeared on the insurer's internal excluded providers list, yet the policyholder found no clear evidence of that exclusion when independently checking the insurer's published hospital directory.
Motor insurance
Motor Accident Claim Denied Over Video Evidence Dispute, Then Reversed After Escalation
A policyholder whose vehicle was damaged in a parking-lot collision had her third-party liability claim rejected after the insurer argued that CCTV footage showed no contact, but she persisted with her appeal and the insurer ultimately reversed its decision and paid in full.
Health insurance
Autoimmune Neurological Attack Claim Denied After Five Claim-Free Years: How One Family Fought Back
A policyholder's mother was hospitalised for a severe autoimmune neurological episode and required high-dose immunosuppressive therapy, but the insurer denied the claim despite five premium-paying years and no prior claims, citing unspecified grounds that contradicted the treating neurologist's written justification.
Health insurance
Health Insurance Claim Rejected Over Alzheimer's and NPH Pre-Existence Allegation Despite No Prior Diagnosis
A policyholder's mother had two hospitalisation claims rejected and her ported health policy terminated after the insurer alleged that Alzheimer's disease and Normal Pressure Hydrocephalus were pre-existing conditions, even though neither had been formally diagnosed before the policy was ported.
Travel insurance
Travel Insurance Claim Denied for Outpatient Treatment Abroad: A Pattern of Third-Party Obstruction
A traveller's legitimate outpatient medical claim was denied by a third-party claims handler working on behalf of a travel insurer, leaving the policyholder without support during a medical emergency abroad.
Health insurance
Health Insurance Claim Stuck in Limbo After Sister's Accident: A First-Claim Nightmare
A long-standing health insurance policyholder's first-ever claim, filed after a family member suffered an accidental fall, remained unresolved for weeks despite multiple escalations, support tickets, and a formal grievance complaint.
Motor insurance
Motor OD Claim Rejected Without Physical Survey: When Remote Photo Assessment Goes Wrong
A policyholder's legitimate own-damage motor claim was summarily rejected after a remote review of photographs, with the insurer alleging the damages were unrelated to the reported accident and "accumulated in nature," despite no formal physical inspection ever being conducted.
Health insurance
Cashless Claim Denied Under "Investigation and Evaluation" Exclusion Despite Acute Emergency Symptoms
A policyholder's wife was admitted as an emergency with breathing difficulty, severe abdominal pain, and acute headache, yet the insurer rejected the cashless claim citing a permanent exclusion for admissions primarily for investigation and evaluation.
Motor insurance
Motor Claim Stalled for Over a Month Because Insurer and Workshop Could Not Coordinate on One Technical Report
A policyholder's car sat at an authorised workshop for more than a month while the insurer waited for a single technical report from the manufacturer, and neither party took ownership of obtaining it.
Motor insurance
Motor Insurance Claim Partially Denied: Pre-Existing Bumper Damage Used to Reject Replacement
A motor insurance policyholder whose vehicle suffered significant rear-end damage in an accident had his bumper replacement claim rejected by the surveyor on the grounds of a minor pre-existing scratch, despite the new damage being clearly caused by the accident.
Health insurance
Health Insurance Complaint Stuck in Acknowledgement Loop With No Resolution Owner
A health insurance policyholder escalated a complaint to the insurer's Grievance Redressal Officer but received two separate acknowledgement emails from two different managers within four days, with no substantive update, no clear owner, and no resolution after the case passed through five internal teams.
Health insurance
Cashless Claim Denied During Dengue Scare: When Insurers Second-Guess Doctors
A policyholder admitted to hospital on a doctor's explicit advice for persistent high fever was twice refused a cashless claim on grounds of "medical necessity not established," forcing full out-of-pocket payment despite clear clinical documentation.
General insurance (policy renewal)
Add-On Rider Silently Downgraded at Renewal Without Policyholder Consent
An insurance agent discovered that add-on riders for two clients were quietly reduced at renewal, with no prior notice, consent, or communication given to the policyholders or their agent.
Health insurance
Health Insurance Cancellation: 40% Premium Deducted Despite Verbal Promise of Near-Full Refund
A policyholder who cancelled a health insurance policy without making any claims received only about 60% of the premium paid, despite being verbally assured at the time of sale that cancellation would result in an almost full refund.
Health insurance
Health Claim Partially Settled With No Explanation: A Transparency Failure
A policyholder received a partial health insurance settlement with deductions but could not obtain a clear breakdown, a list of non-payable items, or the promised supporting documents from the insurer.
Burglary insurance
Burglary Claim Rejected Despite CCTV Evidence and Broken Security Fixtures
A commercial policyholder's burglary claim for approximately six lakh rupees was rejected on the ground of no forcible entry, even though the insurer's own surveyor observed broken security fixtures on the boundary wall and reviewed CCTV footage showing multiple intruders entering the premises.
Health insurance
Cashless Claim Denied Without Investigation During Child's Emergency Hospitalisation
A father sought emergency cashless hospitalisation for his son but received a liability denial with no investigator visit, no video verification, and no contact from the insurer's claims team.
Health insurance
Health Insurance Claim Denied for Alzheimer's and NPH Based on Symptom History, Not Diagnosis
A policyholder's mother had her hospitalisation claims for NPH and Alzheimer's disease rejected after porting her health policy, with the insurer citing behavioural symptom descriptions in discharge summaries as evidence of pre-existing conditions, despite no prior diagnosis existing before the policy was issued.
Health insurance
Health Insurer Rejects First-Ever Claim After Two Years of On-Time Premiums
A policyholder who paid health insurance premiums on time for two years had their very first hospitalisation claim rejected on grounds that reportedly contradict the policy's own terms, and received no meaningful response from the insurer's grievance channels.
Motor insurance
Motor Insurance Claim Rejected for "Minor Pre-Existing Marks" on Bumper After Accidental Damage
A policyholder's motor insurance claim for a damaged rear bumper was rejected on the grounds of minor pre-existing marks, despite no prior claims history, and the authorised workshop charged an undocumented cash fee for a damage estimate.