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At Bima Samadhan, we are committed to providing comprehensive assistance to individuals whose health insurance claims have been unjustly rejected. Our systematic approach ensures that each complaint is meticulously reviewed, analyzed, and represented with professionalism. Here's how we handle health insurance claim rejection cases:

1. Detailed Complaint Review:
   Upon receiving a complaint, we begin by listening attentively to the client's concerns. We ask for all relevant documents, including the policy document, claim rejection letter, follow-up communications with the insurer, detailed policy terms, and all claim-related paperwork. This step allows us to understand the case thoroughly and gather the necessary evidence to move forward.

2. Comprehensive Case Analysis:
   Once we collect the required documents, our team conducts an in-depth analysis of the case. We review the claim details and the insurer's reasons for rejection, ensuring that the case is genuine and has merit based on the available evidence. If the case appears valid, we accept it for representation.

3. Service Agreement:
   After we decide to take up the case, we request the client to formally register with us by signing a service agreement. This agreement defines the scope of our services, the terms of engagement, and ensures transparency between us and the client, setting the foundation for our professional relationship.

4. Drafting the Case:
   Once the service agreement is signed, we prepare a detailed case draft. This involves compiling all the evidence, such as facts, policy terms, and IRDAI regulations relevant to the rejection. We ensure that every argument is well-structured and supported by the necessary documentation before submitting the case to the insurance company.

5. Submitting and Escalating the Case:
   After drafting the case, we submit it to the relevant insurer. If the insurer does not respond adequately, we escalate the case to the appropriate authorities, such as the Insurance Regulatory and Development Authority of India (IRDAI) or the Insurance Ombudsman, ensuring that it receives the proper attention and resolution.

6. Client Support Throughout the Process:
   Throughout the entire process, we provide continuous support to our clients. We keep them informed of the case's progress and are always available to address any questions or concerns. Whether it's gathering additional documents or responding to queries from the insurer, we assist our clients at every stage.

7. Case Resolution and Success Fee:
   Our ultimate goal is to resolve the case in favor of the client. Whether it involves claim approval, compensation, or another satisfactory outcome, we work diligently to achieve a positive result. Once the case is successfully resolved, we charge a success fee as agreed in the service agreement, which is only applicable once the desired result is achieved.

By following this structured process, Bima Samadhan ensures that every health insurance claim rejection complaint is managed effectively, offering personalized support and striving for the best possible outcome for our clients.

Disclaimer:

1. The term 'genuine' in our process refers to cases that present legally valid proofs and supporting evidence to substantiate the complaint. This does not imply that cases lacking such evidence are inherently false or misleading. We encourage clients to provide as much documentary and electronic proof as possible to strengthen their case.

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2. The outlined process serves as a general framework for how Bima Samadhan handles health insurance claim rejection complaints. However, each case is unique, and the steps involved may vary based on the specifics of the case, the nature of the complaint, and the evidence provided.