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Jayanta Bandyopadhyay 28 August 2024

Abrupt stoppage of agreed insurance benefit

I had a policy with care health insurance towards doctors visit fees max up to Rs.1500

During currency of Policy, they cited termination of contract with Apollo Hospitals Kolkata, where my oncology treatment is going on. I approached Ombudsman but she did not listen to my saying and ruled in favour of Insurer. Apollo clearly denies any such termination by Insurer. Care Health refuses to share a copy of termination of agreement with Apollo. How to escalate the issue

Can not appoint lawyer as my treatment eats into all savings.

Learning

3 Replies

T. Kalaiselvan, Advocate (Advocate) 28 August 2024

The insurance ombudsman will not give you any favorable decision.

You can approach consumer commission with a complaint against the insurance company for deficiency in service and unfair trade practice and seek remedy

Jayanta Bandyopadhyay 28 August 2024

Dear Sir

I have complained to Consumer Forum at State & Central level besides IRDAI,Ombudsman HQ unsuccessfully. No response. Even PMO did not intervene.

Regards

Rama chary Rachakonda (Secunderabad/Telangana state Highcourt practice watsapp no.9989324294 ) 28 August 2024

An abrupt stoppage of an agreed insurance benefit can be a distressing experience, especially if you're relying on that benefit. Here are some potential steps to consider: 1. *Review policy documents*: Check your insurance policy to understand the terms and conditions, including any conditions that might have led to the stoppage. 2. *Communicate with the insurer*: Reach out to the insurance company to understand their perspective and reasons for stopping the benefit. 3. *Check for disputes or issues*: Verify if there are any pending disputes, claims, or issues that might have caused the stoppage. 4. *Seek legal advice*: Consult with a legal expert specializing in insurance law to explore your options and potential recourse. 5. *File a complaint*: If necessary, file a complaint with relevant authorities, such as the Insurance Regulatory and Development Authority (IRDAI) or the Insurance Ombudsman. Additionally, consider the following: - *Documentation*: Gather all relevant documents, including policy papers, communication with the insurer, and any other supporting documents. - *Timeline*: Keep a record of events, including dates and details of conversations with the insurer. - *Support*: Reach out to friends, family, or a support group for emotional support during this challenging time. Remember, it's essential to stay proactive and assertive when addressing the abrupt stoppage of an agreed insurance benefit.

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