HEALTH INSURANCE PORTING - REJECTION OF CLAIM
8 months ago
The family health insurance policy taken from National Insurance Co. in the year 2005, renewed without any break, was ported to Manipal Signa in the year 2019.
A claim was made in June 2023, but was rejected on the ground of non-disclosure (violation of policy terms) of a treatment that was undergone in the year 2009, the claim of which was granted by National Insurance.
Since the ported policy is a continuation of the previous policy that was renewed every year without break, can the new insurer reject a claim on the ground of non-disclosure?
A.Dear client,
send a legal notice to the Insurance Company and file a complaint u/s.35 of the CPA, 2019 against the Insurance Company Manipal Sigma for deficiency in service and unfair trade practise, requesting the total amount admissible under the policy as well as compensation for harassment and litigation costs. The complaint must be filed with the Consumer Court within two years after the date of the cause of action, i.e. the claim's rejection.
send a legal notice to the Insurance Company and file a complaint u/s.35 of the CPA, 2019 against the Insurance Company Manipal Sigma for deficiency in service and unfair trade practise, requesting the total amount admissible under the policy as well as compensation for harassment and litigation costs. The complaint must be filed with the Consumer Court within two years after the date of the cause of action, i.e. the claim's rejection.
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A.Dear Client,
Pre Existing Diseases (PED) are covered after completion of a lock-in period that varies depending upon the nature and category of diseases from 24 months to 48 months from the inception of the Health Insurance Policy that is renewed continuously for the lock-in period and thereafter. Since the health insurance policy was renewed continuously for more than 48 months from the date of inception, the policy covers all the PED as per the terms of the policy. On portability of health insurance policy from one insurer to another, all the benefits under the policy are available to the insured person on continuous renewal of the policy. When a treatment was undergone in the year 2009, and the claim was approved by the previous Insurer, National Insurance, on the portability of the policy, the New Insurer, Manipal Signa is aware of the past claim records of the insured and portability does not require fresh declaration or disclosure of the condition of health which is already covered on continuous renewal of the policy. Therefore, repudiation of a claim on the ground of non-disclosure of a treatment that was undergone in the year 2009, is not acceptable being unfair and arbitrary so far as the provision of IRDA(Protection of Interest of Insured) Regulation, 2016 is concerned. Reach out to an Advocate experienced in consumer protection laws to serve a legal notice to the Insurance Company and to file a complaint u/s.35 of CPA, 2019 for deficiency in service and unfair trade practice against the Insurance Company Manipal Sigma claiming entire claim admissible under the policy and compensation for harassment and cost of litigation. The complaint needs to be file before the Consumer Court within two years from the date of cause of action i.e, repudiation of the claim.
Pre Existing Diseases (PED) are covered after completion of a lock-in period that varies depending upon the nature and category of diseases from 24 months to 48 months from the inception of the Health Insurance Policy that is renewed continuously for the lock-in period and thereafter. Since the health insurance policy was renewed continuously for more than 48 months from the date of inception, the policy covers all the PED as per the terms of the policy. On portability of health insurance policy from one insurer to another, all the benefits under the policy are available to the insured person on continuous renewal of the policy. When a treatment was undergone in the year 2009, and the claim was approved by the previous Insurer, National Insurance, on the portability of the policy, the New Insurer, Manipal Signa is aware of the past claim records of the insured and portability does not require fresh declaration or disclosure of the condition of health which is already covered on continuous renewal of the policy. Therefore, repudiation of a claim on the ground of non-disclosure of a treatment that was undergone in the year 2009, is not acceptable being unfair and arbitrary so far as the provision of IRDA(Protection of Interest of Insured) Regulation, 2016 is concerned. Reach out to an Advocate experienced in consumer protection laws to serve a legal notice to the Insurance Company and to file a complaint u/s.35 of CPA, 2019 for deficiency in service and unfair trade practice against the Insurance Company Manipal Sigma claiming entire claim admissible under the policy and compensation for harassment and cost of litigation. The complaint needs to be file before the Consumer Court within two years from the date of cause of action i.e, repudiation of the claim.
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MOHAN IDICULLA
Replied 8 months ago
Legally informative reply. Definitely helpful.
A.Dear Sir,
In many cases such game being played by Insurance Companies. Better approach Insurance Ombudsman and thereafter get issue a legal notice and go to Consumer Forum.
In many cases such game being played by Insurance Companies. Better approach Insurance Ombudsman and thereafter get issue a legal notice and go to Consumer Forum.
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