repudiation of mediclaim
abhijit
(Querist) 22 December 2015
This query is : Resolved
insurance company deliberately repudiating my mediclaim under their own clause and neglecting my medical records.they are not considering merit of my case and putting "age related" excuse although my case is excluded from that as per medical record. Where should i get justice to get rid of their sterotype reply and not going into facts of my case
Kumar Doab
(Expert) 22 December 2015
The claim has already been repudiated.
The options are complaint to IRDA,Insurance Ombudsman, DCDRF....
Rajendra K Goyal
(Expert) 22 December 2015
Lodge complaint with the consumer forum.
Guest
(Expert) 22 December 2015
Go to Ombudsman first and meanwhile prepare for litigation.
Read your policy regarding terms and conditions of policy minutely and see what it says. match with your case and see if they are right or you.
You can go to consumer forum too and be prepared to go right up to NCDRC ( total 4 years-5 years) as insurance companies wont relent easily. IF YOU WANT TO EXPEDITE , APPEAR YOURSELF IN CONSUMER COURTS. you can reduce 1-2 years.
It is better to get policies from government owned companies . At least top bosses would listen.
IN Life segment LIC was at top followed by ICICI Pru life for percentage CLAIMS SETTLED.
Advocate Bhartesh goyal
(Expert) 22 December 2015
Issue legal notice to Insurance company and demand your claim amount,if not complied with then file complaint against Insurance company before District Consumer Forum.
alexander
(Expert) 23 December 2015
Your ' cause of action' is not very clear. However Consumers' Forum is the right forum
Dr J C Vashista
(Expert) 25 December 2015
Move to Consumer Disputes Redressal Fora through a local lawyer.
Guest
(Expert) 25 December 2015
It is unfortunate in India that most businessmen dont respect contracts , act dishonestly and dont even obey court orders.
Most Insurance companies first try to find fault and avoid payments. Hence when one buys insurance product please chose a good company with track record of claim settlement % wise and average period wise.
Then understand product and its terms. For example for buying life insurance of say 1 crore rupee you got have annual income of Rs 3 lac at least. If not, they can repudiate your claim.People with no income or little income cant buy insurance policy of 1 crore and continue it year to year.
If you drink or take some drugs please declare while buying medical policy. Your premium may go up a little but you wont face problem of rejection later.
Insurance is not an investment it is risk coverage for particualr risk , say sudden death causing loss of incoem to your near dears, and people should not think that pay premium and get gift of lump sum payment from company or a means to create easy wealth
T. Kalaiselvan, Advocate
(Expert) 02 January 2016
The consumer forum is the right place to get your grievance redressed on all such issues.
Guest
(Expert) 02 January 2016
Consumer forum means 3-4 years in district ,appeal by company instate commission another 2 years and then RP in national commission which means another 2-2 years.
The consumers forum don't grant any interim relief to consumer . That is weakest link and don't punish adequately these corrupt companies.
Guest
(Expert) 02 January 2016
Mr. Abhijit,
About your statement, "deliberately repudiating my mediclaim under their own clause," would you like to clarify, what do you mean by DELIBERATELY, if the condition pertains to the policy, as may duly have been accepted by you?
Further. did you have not accepted that clause of the Insurance company while applying for the mediclaim policy or by raising any dispute at the time of issue of the policy?
If not and you still have been continuing with the insurance of the company with the same clause, you can't blame the company to be deliberately repudiating the claim. In that case, there being inherent acceptance of the clause on your part, you cannot expect any verdict of any forum, like the insurance ombudsman, consumer forum or even the court of law, in your favour.
Further, so far as your statement, "they are not considering merit of my case and putting "age related" excuse although my case is excluded from that as per medical record," is concerned, you have not provided any detail with reference to which condition of the insurrance policy or the provision of any law/rule, your case is excluded from that condition of the policy. In business law merit of individual's case has no relevance over the contracted terms entered in to by both the parties.
When nobody tries to question the insurace company at the first stage and applies for mediclaim policy without applying their mind on the conditions for the isue of the policy, there is no use in knocking the door of any forum or the court. In fact nobody tries to apply his mind before applying for the mediclaim when green pasteur is shown by the companies through their marketing gimmicks or their agents.
However, in spite of all that, if you still feel that your case has some merit, you may first try to file complaint with the Insurance Ombudsman, thereafter with the IRDAI, then the Consumer Forum.
