Medical Insurance claim has been rejected. What can do legally?
2 years ago
My medical insurence claim has been rejected by HDFC ERGO because I hospitalized during the previous where my Sum insured balance got exhausted. My 17 days hospitalization covered 7 before previous tenure and remaining 10 days in new tenure. My insurence was renewed well in time. Even I requested to pass the claims of last 10 days bills. But still they deny saying the hospitaliaatiin date was the previous tenure where total sum assured balance got exhausted.. Pls consult.
Ayantika Mondal @ Prime Legal
Responded 2 years ago
A.Hi,
As per your narration, the private corporation might have overlooked the billing history which is clearly a fault on their behalf. You may write a complaint addressed to the MD and the manager of your respective bank. Further, you can also file complaint before the consumer forum.
If you find my answer helpful then kindly rate me.
As per your narration, the private corporation might have overlooked the billing history which is clearly a fault on their behalf. You may write a complaint addressed to the MD and the manager of your respective bank. Further, you can also file complaint before the consumer forum.
If you find my answer helpful then kindly rate me.
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A.Hi,
There are two legal recourses left after you have served the legal notice to the private insurance company to reconsider the billing. First, you can refer your dispute to the Banking ombudsman of your region and register a complaint. Second, you may simultaneously file a suit before the consumer court for deficiency in services.
If you find my answer helpful then kindly rate me.
There are two legal recourses left after you have served the legal notice to the private insurance company to reconsider the billing. First, you can refer your dispute to the Banking ombudsman of your region and register a complaint. Second, you may simultaneously file a suit before the consumer court for deficiency in services.
If you find my answer helpful then kindly rate me.
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Pardeep Kumar Dhiman Dhiman
Responded 2 years ago
A.Sir first you give a legal notice to HDFC bank. Because the relation ship between you and bank like a consumer. So you are the consumer of the bank. If bank do not give any response you.
Lastly you sue a case in consumer protection forum. To compensation and damages and harassment. I thik you shall be success your case.
So if my answer is help ful for your problem please response my answer. Thanks
Lastly you sue a case in consumer protection forum. To compensation and damages and harassment. I thik you shall be success your case.
So if my answer is help ful for your problem please response my answer. Thanks
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Sidhaarth
Responded 2 years ago
A.Get issued legal notice and file consumer complaint and also claim damages.
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Vaidehi Samant
Responded 2 years ago
A.Better negotiate with the senior officer personally seeking appointment, with your all documents in hand as proof and also take a lawyer or your CA along who can understand better whatever the officer says and get your claim revised by them. If they don't cooperate with you or you are still not satisfied you may file a suit or seek arbitration in the matter depending on the contract or agreement through which you have availed insurance (you got to check what it says for disputes) against them in the Court of law but considering that litigation is time and money consuming you got see that the amount is worth filing and claiming through litigation otherwise keep it amicable to avoid unnecessary bitterness. Thank you.
If you have found the answer helpful than please provide review and give ***** as appreciation.
If you have found the answer helpful than please provide review and give ***** as appreciation.
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A.Its a general trend with insurance companies to repudiate the claim at the first instance and send the rejection letter when the claim is submitted by the claimant and that's the reason that so many cases are pending with Insurance ombudsman as well with the consumer forum.
You have a very good case to be taken to the consumer forum. Hire a good consumer lawyer and file a case immediately.
You have a very good case to be taken to the consumer forum. Hire a good consumer lawyer and file a case immediately.
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