Health Insurance Claim Status: How to Track, Interpret & Escalate
Submitting a claim is only half the journey. Knowing how to track its progress, understand what each status means, and act quickly when something stalls - that is what ensures your money reaches you on time. This guide covers every stage of the claim lifecycle from registration to settlement under your group health insurance policy.
Why Claim Status Tracking Matters
Once you submit a reimbursement claim or receive cashless pre-authorisation, the claim enters a multi-stage review process at the TPA. Each stage has a different status, a different timeline, and - crucially - different actions required from you. Missing a TPA query or failing to respond to a document request can freeze your claim indefinitely.
As of 2026, IRDAI mandates that insurers settle health insurance claims within 30 days of receiving complete documents. Delays beyond this entitle you to penalty interest. Tracking your claim status ensures you know when the clock starts, when it is paused, and when to escalate.
Every Claim Status Explained - and What to Do Next
Claims go through multiple stages between submission and settlement. Here is a complete guide to every status you may see - what it means, and the exact action required from your end.
Claim Registered
Same day as submissionYour claim has been logged in the TPA system with a unique reference number.
Save the claim reference number. You will need it for all future communication.
Documents Under Scrutiny
1–3 working daysThe TPA is verifying that all submitted documents are complete, legible, and consistent with the claim form.
No action needed. Keep your phone accessible in case the TPA calls to clarify any details.
Under Review
5–15 working daysA claims assessor is actively reviewing the medical records, diagnosis, and policy coverage to determine eligibility and approve amount.
No action needed unless you receive a query from the TPA. Respond to any queries within 7 days.
Under Query / Docs Requested
Paused until docs receivedThe TPA needs additional documents or clarification before they can process the claim further. This pauses the settlement clock.
Respond immediately. Provide the requested documents within the deadline (usually 7–15 days). Delays here directly delay your settlement.
Approved
Payment within 5–7 working daysThe claim has been approved and the payable amount has been determined. Payment processing has been initiated.
Verify the approved amount against what you claimed. If there are deductions, request an itemised explanation in writing.
Settled
Claim closedThe approved amount has been transferred to your bank account via NEFT. The claim is closed from the insurer's side.
Confirm receipt in your bank account. If the NEFT has not arrived within 7 working days of the settlement date, contact the TPA.
Partially Settled
Can be re-examined within 30 daysA portion of the claim has been settled. The remainder was disallowed due to non-payable items, sub-limits, co-pay deductions, or exclusions.
Request the settlement letter and review all deductions. If any seem incorrect, file a written representation to the insurer's grievance cell within 30 days.
Rejected / Repudiated
Appeal window: 30 days from rejectionThe claim has been denied. The insurer must provide a written reason for rejection.
Read the rejection reason carefully. If it is due to missing documents, resubmit with corrections. If you disagree with the rejection, escalate to the grievance cell or Insurance Ombudsman.
What Information Do You Need to Track a Claim?
Keep these details handy before you contact the TPA or check the online portal. Having them ready saves time and gets you a faster, more accurate update.
Policy Number
Printed on your health insurance card or policy schedule
Claim Reference Number
Issued by the TPA at the time of claim registration
Name of Insured Patient
Exact name as per the policy - may differ from common name
Date of Admission or Treatment
For hospitalisation or OPD claims respectively
Name of Hospital / Clinic
Where the treatment was received
Registered Mobile Number
The number linked to your policy for OTP and communication
TPA Name
Your Third Party Administrator - check your health card or policy
Employer / HR Contact
For GMC policies, HR may hold additional claim details
Bank Account Details
For confirming NEFT transfer once claim is approved
Four Ways to Track Your Claim Status
Choose the tracking method that best suits your situation. For urgent cases or claims that appear stuck, the helpline or SecureNow escalation is faster than portal self-service.
Insurer / TPA Online Portal
FastestMost insurers and TPAs provide 24/7 self-service portals where you can view real-time claim status, download settlement letters, and upload additional documents.
- 1.Visit your insurer's or TPA's official website
- 2.Log in with your policy number and registered mobile number
- 3.Navigate to 'My Claims' or 'Claim Status' section
- 4.Enter your claim reference number to view full status and history
TPA / Insurer Helpline
Recommended for Urgent CasesA phone call is the most direct way to get a status update and speak to a claims executive who can flag stalled cases internally.
- 1.Call the TPA helpline number printed on your health insurance card
- 2.Have your policy number, claim reference, and registered mobile ready
- 3.Ask for a specific status update and the expected settlement date
- 4.Request escalation if the claim has been pending beyond the stated timeline
WhatsApp & Mobile Apps
Convenient for UpdatesAs of 2026, several major TPAs and insurers offer WhatsApp-based claim status bots and dedicated mobile apps with push notifications for every status change.
- 1.Register your mobile number on the insurer's app or WhatsApp channel
- 2.Send your claim reference number to the WhatsApp business number
- 3.Receive automated status updates and document request notifications
- 4.Use the app to upload additional documents directly without visiting the TPA office
Email to Claims Team
Best for DocumentationEmail creates a written record of all communications - important if you later need to escalate or prove that you responded to a query on time.
- 1.Email the insurer's or TPA's claims team with your policy and claim reference in the subject line
- 2.Include your registered mobile number and date of claim submission
- 3.Request a written status update and expected settlement date
- 4.Keep all email responses saved for your records
IRDAI-Mandated Claim Processing Timelines
IRDAI sets strict timelines for claim processing. Knowing these protects you - if an insurer exceeds these limits, you are entitled to escalate and may be eligible for penalty interest on delayed payments.
Source: IRDAI Health Insurance Regulations and Master Circular on Health Insurance, updated 2024. Verify current norms at irdai.gov.in.
When and How to Escalate a Delayed or Rejected Claim
If your claim is not progressing, you have a structured escalation pathway. Each level has a defined trigger and a specific contact point. Always exhaust lower levels before escalating further.
Level 1
Contact TPA Helpline Directly
WHEN TO USE
Claim pending for more than 15 working days with no update
CONTACT
TPA helpline (on your health card)
Level 2
Contact SecureNow Claims Team
WHEN TO USE
TPA helpline has not resolved the issue within 3 working days
CONTACT
+91 9696683999 / support@securenow.in
Level 3
File with Insurer Grievance Cell
WHEN TO USE
Claim pending beyond 30 days or TPA escalation unsuccessful
CONTACT
Insurer's official grievance email / registered office
Level 4
Insurance Ombudsman
WHEN TO USE
Insurer grievance unresolved for 15+ days or response is unsatisfactory
CONTACT
IRDAI Ombudsman for your region (irdai.gov.in)
Level 5
IRDAI Bima Bharosa Portal
WHEN TO USE
For systemic issues or when other channels have been exhausted
CONTACT
bimabharosaportal.irdai.gov.in
Your Rights Under the Insurance Act
If an insurer delays settlement beyond 30 days of receiving complete documents without reasonable cause, they are liable to pay interest at 2% per annum above the bank rate for the delayed period. Document all submission dates and keep acknowledgement receipts as evidence.
Claim Settled for Less Than You Expected? Here Is What to Do
A partial settlement is not necessarily a final answer. Before accepting it, review the deductions carefully - many partial settlements include avoidable or incorrectly applied deductions.
Request the Settlement Letter
Ask the TPA for an itemised settlement letter that lists every deduction - its reason, the policy clause invoked, and the amount disallowed. This letter is mandatory and the insurer must provide it.
Review Each Deduction Against Policy Terms
Cross-check every deduction against your policy schedule and the IRDAI non-payable items list. Common errors include incorrect co-pay application, room rent calculations, or disallowing items that are actually covered.
File a Written Representation
If you identify an incorrect deduction, write to the insurer's grievance cell within 30 days. State the deduction, the reason you believe it is wrong, and cite the specific policy clause. Attach the relevant documents.
Contact SecureNow for Claim Review
SecureNow's claims team can review your settlement letter against your policy terms and advise whether the deductions are valid. We also represent employees in formal disputes with the insurer on your behalf.
Escalate to Insurance Ombudsman
If the insurer does not respond satisfactorily within 15 days of your grievance, escalate to the Insurance Ombudsman for your region. The Ombudsman can award claims up to ₹50 lakhs through a free, time-bound arbitration process.
IRDAI Bima Bharosa Portal
For systemic issues or when other channels have failed, file a complaint on IRDAI's Bima Bharosa portal. Insurers are required to acknowledge complaints within 3 working days and resolve them within 14 days.
Key Takeaway
Tracking your claim is not passive waiting - it is active management. Know your claim reference number from day one, check the status every 5–7 days, and respond to TPA queries without delay. IRDAI mandates 30-day settlement from the date of complete documents - if that window is breached, you have the right to escalate. A partial settlement or rejection is not always final - review every deduction, write a formal representation, and escalate if needed. For support at any stage, SecureNow's claims team is your fastest route to resolution. You can also review the full claims journey via our cashless, reimbursement, and pre & post hospitalisation guides.
Frequently Asked Questions
Common questions about tracking, interpreting, and escalating health insurance claims in India.
You can track your claim through four channels: (1) Your insurer's or TPA's online portal using your policy number and claim reference; (2) Calling the TPA helpline; (3) Emailing the claims team; (4) WhatsApp support offered by some TPAs. SecureNow also provides claim status updates directly to employees and HR teams on request.
'Under Review' means the TPA has received your documents and a claims assessor is actively reviewing the medical records, diagnosis, and policy coverage. No action is needed from you at this stage unless the TPA sends a query. A reimbursement claim typically stays 'Under Review' for 7–15 working days.
Cashless pre-authorisation: 1–4 hours. Cashless settlement at discharge: same day. Reimbursement processing: 15–30 working days from the date of complete document receipt. IRDAI mandates settlement within 30 days of receiving all required documents - delays beyond this are subject to penalty interest.
Call the TPA helpline and request a written update. If unresolved within 3 working days, contact SecureNow's claims team - we escalate stalled claims directly with TPAs. If the claim is pending beyond 30 days, file a formal grievance with the insurer's grievance cell.
'Pending' means the claim is logged but review has not yet started. 'Under Query' means the TPA has reviewed the claim but needs more information from you before proceeding. An 'Under Query' status requires your immediate action - ignoring it pauses your settlement indefinitely.
Yes. If the claim is not settled within 30 days of submitting complete documents, escalate in this order: (1) TPA helpline; (2) SecureNow claims team; (3) Insurer grievance cell; (4) Insurance Ombudsman for your region; (5) IRDAI Bima Bharosa portal.
'Settled' means the insurer has processed the claim and initiated payment. However, 'Settled' does not always mean the full claimed amount is paid. Deductions may apply for non-payable items, co-pay, sub-limits, or exclusions. Review the settlement letter for an itemised breakdown of any deductions.
Bima Bharosa is IRDAI's integrated grievance redressal portal where policyholders can lodge complaints against insurers for claim delays, rejections, or unsatisfactory responses. Insurers are required to respond within 14 days. Complaints can be filed at bimabharosaportal.irdai.gov.in.
Claim Stuck or Settled for Less Than Expected?
SecureNow's dedicated claims team handles TPA follow-ups, document queries, escalations, and settlement disputes on your behalf. Reach out - and let us get your claim moving.