Can medical insurance be rejected
Can medical insurance be rejected
Can medical insurance be rejected for non disclosure of HIV but the patient died in hospital for brain stroke.
8 months ago
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. Insurers cannot refuse to sell you a plan or charge you more just because you have a pre-existing condition such as HIV, cancer, or even asthma. The few insurers provide coverage only to such persons ...ReadMore
Mediclaim policy - Husband has not mentioned his high bp
Husband has not mentioned his high bp during his mediclaim which he has made 2 yrs ago.Now he has had a knee surgery and is claiming an amount from the insurance company.Hospital documents have reveal
8 months ago
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. The authenticity and veracity of the hospital report need to be challenged first if the claim against knee surgery is repudiated on the ground of concealment of PED of high BP at the time of inception ...ReadMore
Bike Accident and Death
Hi Legal Expert, My Bike was met a accident with a drunken fellow and he died in hospital . On the time of accident Bike does not have any kind of insurance and its driven by some other person who ac
8 months ago
A. Dear client,
The owner of the vehicle, regardless of who was driving it at the time of accident, is liable to compensate the victim. The liability would shift on the insurance company if there was a third party insurance. Police will file the case in all cases where the victim dies.
Superdari Insurance
Vehicle has been released on Superdari, Can insurance be claimed fro vehicle repair before ending of proceedings from the insurance company?
9 months ago
A. Dear client,
Superdari Proceedings: Superdari is a legal term in India referring to the release of a vehicle or property seized by the police or other authorities during an ongoing investigation or legal proceedings. It allows the owner of the property to retain possession until the conclusion of the case. During Superdari proceedings, the ownership of the vehicle remains with the owner, and they are responsible for the vehicle's maintenance and repair.
Insurance Coverage: In the case of vehic ...ReadMore
Impact of LAMA discharge on Life insurance claim
Hi, My wife passed away last month. She was critically ill and was on death bed. I got her discharged under LAMA so that she could spent her last days with family. She got passed away after 2 days. Sh
9 months ago
A. Dear client,
In most cases, life insurance policies cover death due to natural causes, illness, or accidents, unless stated otherwise in the policy terms and conditions. If your wife's policy does not have any specific exclusions related to LAMA discharges, it is unlikely that the insurance company would reject the claim solely based on that reason. Insurance companies typically investigate claims thoroughly to ensure all necessary information is provided, and they may require documentation suc ...ReadMore
Health Insurance company asking for the MLC certificate but hospital denying MLC
Health Insurance company asking for MLC as it is a road accident, So I requested Hospital for it but hospital that is not the case of MLC My father had a road accident due to driver turned the car in
10 months ago
A. Dear Client,
Medico-Legal Certificate (MLC) is required in cases of a road accident or an incident that has led to injury or death. Sometimes patients are admitted straight to an emergency room for medical attention. In such cases. In government hospitals and most of the major private hospitals, a medico-legal register is maintained wherein accident cases are registered by hospital authorities at the time of admission/treatment and submitted to the local police station. Based on the report, the ...ReadMore
insurance claim by third party
whether the third party of insurance can claim insurance before consumer court ? if not then which court?
10 months ago
A. Dear Sir,
There is one office called Insurance Ombudsman. You must exhaust remedy by approaching the said office and thereafter you can go to Consumer Court.
Regarding sublimit in insurance
I had a insurance policy which had a clause of sublimit or Rs 4,00,000 for Immunotherapy - Monoclonal Antibody to be given as injection. I had total expense of Rs 6,23,940 during hospitalisation and d
10 months ago
A. Dear Client,
This claim by your insurance company depends on two factors:-
1) What the rest of the treatments other than the monoclonal antibody injection were,
2) and Whether these rest of treatments are counted as Immunotherapy according to your insurance policy.
Companies usually have different insurance policies and they have varied definitions of what does and does not count as Immunotherapy.
If your insurance police has clauses that include certain treatments you got along with the mo ...ReadMore
Slip and fall Personal Accident Insurance Claim
Does the incident of slip and fall in bathroom comes under the definition of Personal Accident as per Personal Accident Insurance Policy.
10 months ago
A. Hello,
An identifiable physical injury which is caused by a sudden, unexpected, specific event occurring at an identifiable time and place during the period of insurance and which results in the death, disablement or permanent total disablement of an insured person.
Hospitalisation claim rejection and policy cancellation from Health Insurance Co
My mother has Senior Citizen Health Insurance policy on Feb, 2016 and her hospitalization claim for Respiratory ASTMA disease and Hypertension was rejected from the Health Ins co. stating that she ha
10 months ago
A. Dear Client,
Since the health insurance policy of your mother 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. Repudiation of claim on the ground of PED and cancellation of Renewal of policy after the expiry of look in period is not acceptable being unfair and arbitrary so far the provision of IRDA(Protection of Interest of Insured) Regulation, 2016 is concerned. Reach out to an Advocate experienced in con ...ReadMore
