Health insurance - Tpa rejected my Cancer therapy claim
Tpa rejected my Cancer therapy claim on blaim that I'm tobacco habited as mentioned in last claim by note by hospital
Tpa rejected my Cancer therapy claim on blaim that I'm tobacco habited as mentioned in last claim by note by hospital
Dear client,
A health insurance provider or TPA cannot legally reject your cancer therapy claim solely based on a hospital note of tobacco habit, unless there is clear medical and legal evidence that your claim is outside policy terms or due to misrepresentation.
Key Legal Points
Insurers Must Prove Direct Link: Courts have ruled that insurers cannot deny claims purely because the insured is a tobacco user; they must prove a direct and proximate causal link between the tobacco habit and the il
My mother have a lic insurance policy and paid all premiums from 2001 to 2011 and maturity year is 2027 . My insurance agent is uncle in relation and he take loan of 5 lakh on my mother policy by frau ...
Dear Client,
In the given scenario, you should immediately lodge an FIR against the insurance agent for criminal breach of trust and cheating under Sections 316 and 318 of the Bharatiya Naya Sanhita(BNS) at the local police station and simultaneously file an online or offline grievance in respect of fraudulent act of agent to the concerned GRO of LICI or its branch office from where the policy was issued and loan application was processed along with a copy of FIR. If the insurance company(LICI
Can insurers reject claims & deny payments on the basis of late intimation?My mother passed away around six months ago. She died in an unfortunate accident where she fell off a two-wheeler vehicle ...
Dear Client,
The terms and conditions of an insurance policy are the most crucial and vital to go through before raising a claim against an insurance policy. Based on the self-declaration of the policy buyer and post-medical tests of the insured, wherever required, the risk and coverage are underwritten, and the Actuaries of the Insurance Company calculate the premium following the guidelines of the regulatory authority IRDAI. most insurance policies specify a claim submission timeframe, usuall
1st Transfer then Absconding then Forced resignation then and termination
Dear Client,
Your query suffers from a lack of information and transparency to address it suitably. However, be informed that an order of transfer on administrative reason is also considered a prerogative of the management and disobedience of said order makes an employee to face disciplinary action from the management. Instead of compliance of transfer order, you absconded yourself to avoid the transfer which is typically considered unauthorised absence from work and amounts to misconduct and
My cataract surgery claim short closed due to the sub limit. Cataract surgery done by using advanced technology and toric lens used for medical condition. Lens cost not paid due to sub limit. Is it ac ...
Dear Client,
The terms and conditions of an insurance policy are the most crucial and vital to go through before raising a claim against the health insurance policy. Based on the self-declaration of the policy buyer and post-medical tests of the insured, wherever required, the risk and coverage are underwritten, and the Actuaries of the Insurance Company calculate the premium following the guidelines of the regulatory authority IRDAI. If the tern of policy states that the cost of cataract surge
I have taken vehicle loan on my wife name and she was suffering from cancer and died in 1 month after taking loan during loan papers they haven’t asked about health history and we have not give hist ...
Dear Client,
When a vehicle loan borrower passes away , the primary responsibility for repayment falls to their estate. As the surviving spouse and legal heir, you are generally only liable for the loan up to the value of the assets you inherit from your wife, unless you were a co-borrower or guarantor on the loan. The bank may also have the right to repossess the vehicle, as it served as collateral.
The fact that health history wasn't requested or provided during the loan application is typ
Other Responses
I had taken a health insurance policy from STAR Health for my father. He was later hospitalized and underwent treatment. The insurer approved the claim under cashless, and the hospital bills were sett ...
Dear Client,
The terms and conditions of an insurance policy are the most crucial and vital to go through before raising a claim against the policy. Based on the self-declaration of the policy buyer and post-medical tests of the insured, wherever required, the risk and coverage are underwritten, and the Actuaries of the Insurance Company calculate the premium following the guidelines of the regulatory authority IRDAI. Despite non-disclosure of Pre-Existing disease (PED), some PEDs are covered b
My insurance provider mandates spouse also to have insurance or be covered in my insurance for me to claim Delivery charges. I am covered under insurance and completed the waiting period. Since I am t ...
Dear Client,
When an insurance claim is repudiated/rejected by the Insurance company, they inform the insured person of the reason/ground behind the rejection of the claim. Your query lacks that information, and consequently, in the absence of grounds/reasons behind the rejection of an insurance claim, no remedies to your grievance can be suggested as of now. However, be informed that the terms and conditions of an insurance policy are the most crucial and vital to go through before raising a c
Insurance claim rejection saying there was no need for Hospitalization. My wife who is also also covered with health insurance was admitted in the hospital. Since the hospital was not cashless we have ...
Dear Client,
When an insurance claim is repudiated/rejected by the Insurance company, they inform the insured person of the reason/ground behind the rejection of the claim. Your query lacks that information and consequently, in the absence of grounds/reason behind the rejection of an insurance claim, no remedies to your grievance can be suggested as of now. However, be informed that the terms and conditions of an insurance policy are the most crucial and vital to go through before raising a cla
IF RC AND DL ARE DIGITALLY IMPOUNDED, IS THE VEHICLE OR THE DL OWNER FIT TO DRIVE THE VEHICLE. IN CASE THERE IS AN ACCIDENT INJURING THIRD PARTY, IS THE CLAIM PAYABLE IF RC OF THE ACCIDENTAL VEHICLE O ...
Dear Client,
Digitally impounded RC and/or Driving License is considered deemed suspension of the documents usually done in case of violation of traffic rules and involves potential risk and complexity. In case the Owner or Driver of a vehicle meets with a road accident while driving a vehicle holding a digitally impounded RC and DL, may face penalties, fines, or even imprisonment, depending on the severity of the offence apart from the repudiation of insurance claim by the Insurer. It is not re
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