Cancel of health policy

Querist : Anonymous (Querist) 07 November 2010 This query is : Resolved
I was taken health policy from ICICI Lombard 4 months back for my 4 yrs old son who is suffering epileptical problem. las month he addmitted in Jupiter multispeciality hospital at Thane for viral infection treatment. through hospital claim for cashless facility with sufficient information. But ICICI lombard denied the claim due to pre existing dieses which was not included in policy application form at the time of taking policy. But patient was not addmitted for epileptical treatment he was admitted for control fever and related treatement only. Now ICICI lombard is cancelled policy and refund premium amt by courier without intimation to me. I want to legal action with ICICI lombard. Pl guide me.

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Arun Kumar Bhagat (Expert) 07 November 2010
You can file case in consumer forum and take up the matter with Insurance Regulatory Authority of India.

adv. rajeev ( rajoo ) (Expert) 07 November 2010
I do agree with Bharat.

Parthasarathi Loganathan (Expert) 07 November 2010
Generally we pay scant importance to the terms and conditions imposed in the term policy and take some assumptions based on the feedback given by the marketing personnel of any insurance company. Consequently at the time of any claim such companies would evade coverage on some pretext or other to exclude their liability. Though legal solutions could not be ruled out, but it would be a futile exercise to contest against major insurance companies who are themselves advised by eminent legal experts to defend their cases against them.

Since you are not put to any monetary loss right now as the premium is refunded and your child is OK with minor ailments, better approach any other Insurance companies who specifically include the said disease under the purview of coverage. That is feasible option.

Raj Kumar Makkad (Expert) 07 November 2010
I also agree

Kirti Kar Tripathi (Expert) 07 November 2010
I do not agree with Mr. Parth. in this way it is walk over to insurance company. my suggestion is to file consumer case and also to make complaint to Insurance Regulatory Authority of India.

Khaleel Ahmed Mohammed (Expert) 07 November 2010
Mr.Kirti Kar is right.

R.Ramachandran (Expert) 08 November 2010
The first question to be asked is whether at the time of taking the policy whether the pre-existing disease of the 4 year old son was disclosed or not. If not disclosed, the insurance company is well within its rights to cancel the policy. After all, the Insurance policy is based on the doctrine of 'ubarima fide' i.e. utmost good faith on both sides. The person getting insurance is expected to disclose complete facts. Non-disclosure of such facts in itself would disentitle him to any insurance claim.

Parthasarathi Loganathan (Expert) 08 November 2010
As opined by Mr.Ramu, Insurance Companies take advantage of even 1% non-disclosure of facts directly or indirectly. Keeping this as a back-end experience all such terms could be discussed and negotiated with the new Insurance Company to secure the interests rather than resorting to litigation which would be fruitless for the common man. I am sharing only my experience in this regard.

s.subramanian (Expert) 08 November 2010
Non disclosure clause will be against you. However approach the Consumer court.

Uma parameswaran (Expert) 08 November 2010
File a case before Consumer Forum.

Chanchal Nag Chowdhury (Expert) 08 November 2010
U have a first class case in the Consumer Court.

A. A. JOSE (Expert) 09 November 2010
You may move the Consumer Forum immediately as you have a valid grievance.

Cancel of health policy

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