Claim Tracking · Status Guide
Health Insurance Claim Status: How to Check & What Each Status Means
Tracking a submitted claim can be nerve-racking when you encounter confusing insurance terminology on web portals and SMS alerts. Here is how to check your health insurance claim status across insurers and TPAs, what each status actually signifies, and the exact legal next steps.
By the MediclaimSaathi team Updated 5 November 20267 min read
Quick answer
You can check your health insurance claim status on your insurer or TPA portal using your Claim Number and Policy Number. Statuses like "Query Raised" require submitting specific medical records within 15 days; "Investigation" means a field agent is verifying hospitalization; "Approved" indicates settlement; while "Repudiated" means formal rejection with an appeal right to the Grievance Redressal Officer.
How to Check Your Health Insurance Claim Status Online
In India, health claims are processed either in-house by the insurer’s internal claims management team or through a licensed Third-Party Administrator (TPA) such as Medi Assist, Paramount, Vidal Health, MDIndia, or FHPL. You can track status across multiple digital and telephonic channels.
- 1Insurer Web Portal or Mobile AppVisit your insurer’s official portal (e.g., Star Health, Care, HDFC ERGO, Niva Bupa, ICICI Lombard, New India Assurance). Navigate to the "Track Claim" section, enter your Claim Number or Policy Number along with Date of Birth or registered mobile number, and view real-time stage updates.
- 2TPA Tracking DashboardIf your policy is serviced by a TPA, locate your TPA ID on your health card. Visit the TPA website or mobile application, enter your TPA ID and Claim Reference Number to view itemized scrutiny notes, deficiency memos, and payment transaction IDs.
- 3Insurer Toll-Free IVR & WhatsApp ServicesMost major insurers offer 24x7 automated IVR tracking and WhatsApp bots. Send "Track [Claim Number]" to the insurer’s verified business WhatsApp number to receive an immediate status breakdown.
- 4Hospital Insurance HelpdeskFor ongoing cashless claims, the hospital TPA billing desk has direct portal access to the insurer’s authorization console and can check live status notes, pending approvals, and query memos.
Detailed Status Dictionary: What Each Claim Status Means
When tracking your claim, insurers display automated stage codes. The table below decodes the 8 most frequent claim statuses and specifies the exact action you must take.
| Claim Status | Plain-English Meaning & Immediate Action Required |
|---|---|
| Claim Registered / Logged | Your claim dossier or intimation has been received by the TPA/insurer system and assigned a unique Claim Number. Action: Save this Claim Number for all future correspondence. |
| Under Technical / Medical Review | In-house medical doctors are reviewing your indoor case papers, diagnosis, and bills against policy terms and medical necessity. Action: No action needed; standard scrutiny takes 7–10 days. |
| Query Raised / Deficiency Memo | The insurer needs specific missing records (e.g., doctor prescription, detailed bill breakup, pathology report). Action: Collect and submit the exact requested documents within 15 days with an acknowledgment. |
| Under Field Investigation | The insurer has assigned an external investigator to verify genuine hospital admission, check hospital registers, and confirm medical history. Action: Cooperate, verify the investigator’s ID, but never sign blank forms. |
| Approved / Settled | The claim has been adjudicated and approved for payment. Action: Verify the approved amount against your bank credit notification. Retain the detailed settlement voucher. |
| Part-Settled / Short-Paid | The insurer paid a portion of the claim but deducted sums under room rent capping, consumables, or non-medical charges. Action: Obtain the line-by-line deduction sheet and file a grievance for unfair cuts. |
| Repudiated / Rejected | The claim has been officially denied citing a policy exclusion, pre-existing disease, or alleged non-disclosure. Action: Demand the formal repudiation letter with specific clause citations to initiate an appeal. |
| Closed / Withdrawn | The insurer archived the claim due to unanswered queries within the deadline. Action: This is NOT a permanent rejection; submit the pending documents with a reopening request immediately. |
When Your Claim Is Stuck for >30 Days: Your Statutory Rights
Under Regulation 27 of the IRDAI (Protection of Policyholders’ Interests) Regulations, insurers are mandated to settle or reject a claim within 30 days of receiving all necessary documents.
If an insurer or TPA keeps your claim pending past 30 days without lawful justification, they are guilty of regulatory delay. You possess enforceable legal rights:
- Mandatory Penal Interest: The insurer must pay penal interest at a rate of 2% above the prevailing bank rate per annum from the 30th day until the date of actual payment.
- Prohibition on Piecemeal Queries: Under IRDAI circulars, the insurer cannot keep your claim perpetually open by sending queries one after another. All queries must be combined in one single letter within 15 days of receiving the claim.
- Right to Issue Legal Demand to GRO: You can issue a formal statutory notice to the insurer’s Grievance Redressal Officer citing IRDAI Regulation 27, demanding immediate settlement plus accrued penal interest.
Costly Mistakes to Avoid While Tracking Claims
- Ignoring Deficiency Queries: Letting a query sit past 15 days risks having your claim file closed without prejudice, requiring extensive administrative effort to reopen.
- Submitting Documents Without Acknowledgment: Never send requested query papers by standard post or informal courier without tracking and stamped proof of delivery.
- Giving Unrecorded Verbal Statements to Investigators: If an investigator visits your home, answer factual questions regarding your admission, but never speculate on previous medical history without reviewing your proposal form.
- Relying on Call Center Assurances: Telephone agents frequently say "it will be processed in 48 hours." Always demand written confirmation via email or portal ticket.
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Check my letter freeFrequently asked questions
How many days does an insurer have to decide a health claim?+
Under IRDAI regulations, an insurer must settle or repudiate a reimbursement claim within 30 days of receiving all required documents. For cashless claims, pre-authorization must be decided in 1 hour and discharge in 3 hours.
What does "Query Raised" mean and how quickly must I reply?+
It means the claims scrutiny doctor requires additional documentation (e.g., diagnostic reports, detailed bill breakdown, or doctor certificate). You must reply within 15 days to prevent the claim from being closed.
Why does my claim say "Under Investigation" if my doctor verified the condition?+
Insurers routinely flag claims filed in early policy years, high-value claims, or admissions at non-network hospitals for field verification. An investigator checks hospital admission registers and pharmacy ledgers to prevent fraudulent billing.
Does "Closed" or "Withdrawn" mean my claim is permanently rejected?+
No. A "Closed" status simply indicates the insurer stopped active review due to non-receipt of query documents. You can reopen the claim at any time by submitting the required documents along with a reopening letter.
What is the difference between "Repudiated" and "Short-Paid"?+
Repudiated means 100% of your claim is denied. Short-paid means the insurer approved your hospitalization but made deductions for room rent limits, non-medical items, or copayments.
Related guides
Claim Guide · Process
Health Insurance Claim Process in India: Cashless vs Reimbursement Explained (2026)
Statutory Defense · Rejection Grounds
Top Health Insurance Claim Rejection Reasons in India & How to Overturn Them
Regulatory Escalation · Bima Bharosa
How to File an IRDAI Complaint Online on Bima Bharosa Portal (Step by Step)
Sources
- IRDAI — Master Circular on Health Insurance Business (May 2024)
- IRDAI Bima Bharosa grievance portal
- Council for Insurance Ombudsmen
This guide is general information, not legal advice. Rules change; always check the current IRDAI circulars and your policy wording. MediclaimSaathi is a document-preparation platform, not a law firm, insurer or broker.