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This rarely occurs, but when it does it could be because of two reasons.
Your sum insured is like a box of a finite number of chocolates; you're free to claim or pick from it as many times as you like in a year. Each time you make a claim, the number of chocolates in the box will decrease. Eventually, your sum insured is exhausted and the amount you receive is less than you expected.
Even though you can claim up to the sum insured, some treatments have monetary limits. A cataract surgery, for example, is only covered up to ₹20,000. Expenses above that amount will not be covered by the insurance company, and you will have to pay them yourself.