Medical claim got Repudiation for Crosspathy, what to do?
2 years ago
As per policy, crosspathy is not payable .Hence the claim is
being denied under clause no 3.25 of the policy.
MEDICAL PRACTITIONER is a person who holds a valid registration from the Medical Council of any State or Medical
Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government
and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of his
license. Note: The Medical Practitioner should not be the insured or close family members
Ayantika Mondal @ Prime Legal
Responded 2 years ago
A.Hi,
If the policy was repudiated for crosspathy, then you will have to approach the consumer forum, and present your case that the repudiation was not valid as the clause of crosspathy was not violated by you. Please consult with an advocate personally, he will advise you further.
If you like my answer, please rate me.
If the policy was repudiated for crosspathy, then you will have to approach the consumer forum, and present your case that the repudiation was not valid as the clause of crosspathy was not violated by you. Please consult with an advocate personally, he will advise you further.
If you like my answer, please rate me.
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A.Hi,
If the terms of the policy clearly mentions that the policy cover will be denied in case of crosspathy, then you will have to prove the otherwise, that the crosspathy was not done in your case.
If you like my answer, please rate me.
If the terms of the policy clearly mentions that the policy cover will be denied in case of crosspathy, then you will have to prove the otherwise, that the crosspathy was not done in your case.
If you like my answer, please rate me.
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A.If crosspathy is not covered as per the policy and its clearly mentioned there then I don't think that you will have any benefit fighting this case legally in court or consumer forum. But I will still suggest that you can take chance and move a petition with the Insurance Ombudsman.
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