Governance: Insurance companies pulled up over mediclaim

With medical costs increasing nowadays to a large degree and with specialized treatment becoming much more expensive, having medical insurance is absolutely necessary. Not having medical insurance means that you can be in a tremendous financial problem when the need arises to avail of medical services. However, it gets problematic when the insurance company uses any means to avoid paying the insurance claim. In such cases, it is the consumer redressal forums that intervene and get the insurance company to pay the claims:

NEW DELHI: The State Consumer Commission has rebuked three public insurance companies for wrongly repudiating the ‘mediclaim policy’ and insurance claims against ‘life-policy’ in four different cases on grounds of concealment of pre-existing ailments. The companies – namely Life Insurance Corporation of India, Oriental Insurance Company and New India Assurance Company – were pulled up by the city’s apex consumer commission for rejecting, ‘on highly flimsy grounds’, legitimate claims made by consumers.
The insurance companies have been directed to pay lakhs in compensation for the wrongful rejection of the claims made under various policies.
Justice Kapoor clearly noted that “Malaise of hypertension,diabetes, occasional pain, cold, headache, arthritis and the likes in the body are the wear and tear of modern day life which is full of tension at the work place … These cannot be used as concealment of pre-existing disease for repudiation of an insurance claim, unless an insured in the near proximity of taking of the policy is hospitalised or operated upon for treatment of these diseases or any other disease.’’

This judgment will be useful for all mediclaim users, given that at the times of emergency when there is a need for money, there should not be the fear that the claim will be rejected for some reason or the other.

3 comments to Governance: Insurance companies pulled up over mediclaim

  • sanjay joshi

    my claim is refused on the ground that pre existing deceased

  • mdesai

    Lack of/poor knowledge of technical & insurance details
    Unpreparedness to assume responsibility for decision
    Absence of accountability
    Regulations & defective surveillance of TPA
    Unqualified substandard semi educated DHMS/ BAMS doctors manning offices, unqualified insurance person
    -Absence of provision of properly punishing harassing TPA staff
    -Absence of controlling improper behaving staff

  • A promise of compensation for specific potential future losses in exchange for a periodic payment. Insurance is designed to protect the financial well-being of an individual, company or other entity in the case of unexpected loss. Some forms of insurance are required by law, while others are optional.Everything you ever needed or wanted to know about disability and long term care insurance.

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