Reimbursement claim in health insurance
My father got slipped and his waist got fractured. When we admitted him to hospital then doctor suggested for surgery. We went through surgery and treatment. Now when I sent expense documents to insur ...
My father got slipped and his waist got fractured. When we admitted him to hospital then doctor suggested for surgery. We went through surgery and treatment. Now when I sent expense documents to insur ...
Dear Client,
Every Hospital/Nursing home keeps an MLC register wherein accident/ assault/poisoning/ burn cases are registered by hospital authorities and submitted to the local police station. Fall and fracture of body parts is considered an accident and comes under the purview of Medico-Legal Cases. A medico-legal case should be registered by the treating Doctor of the hospital as soon as the patient is brought to the Hospital and admitted for necessary treatment. Under Section 39 of Cr.PC, the
So.. I went and hit a car which was second hand and the registration certificate of the same is not been transferred to the car owner. My third party insurance claim is being rejected from the other e ...
Dear Client,
It is mandatory to have a third-party insurance policy as per the Motor Vehicles Act, of 1988 which is a basic requirement to legally ply a vehicle on Indian roads. A major disadvantage to having third-party motor insurance is that you are not covered for any damage to your vehicle in an accident. This means that you will have to pay for any repairs to your vehicle out of your own pocket. A 3rd party insurance policy provides compensation for bodily injuries or demise of a third pa
I already have one heath insurance policy running from myself from ICICI Pru Life and another from LIC in family floater mode. As the aggregated sum assured is still quite low (6 Lakh only). May I tak ...
Dear Client,
A policyholder can have multiple health insurance policies. However, he cannot claim reimbursement for the same expense from multiple insurers. If one cover is not sufficient, the other cover can be used to cover the expenses. Having two/three health plans can help cover normally out-of-pocket medical expenses, but also means you'll likely have to pay two premiums and face two deductibles. Your primary plan initially picks up coverage costs, followed by the secondary plan.
Hi team, I have a LIC policy, Jeevan Aadhar (114) with me as life insured and my mentally retarded sister as nominee. The agents(2 agents) told this is a special plan for differently abled children. T ...
Dear Client,
In the prevailing situation you may take the following stemps to redress your grievance - 1) File a Grievance before the GRO of the Divisional Office of the LIC conderned, 2) File a complaint under IRDA(Protection of Policyholders Interest) Regulations, 2002 online in the official portal or in offline mode in a prescribed format available on the official website of IRDA, 3) File a omplaint before the Insurance Ombudsman concerned, 4) File a complaint against the concerned agents for
Can i claim my remains medical expenses bill to my health insurace company if I received partial fund from chief minister relief fund. Suppose my total medical expense is rs 750000 n I received 200000 ...
Dear Client,
In the situation, when your medical expenses are more than the sum you received from the CM's relief fund which is insufficient to cover your medical expenses and you are a policyholder of the health insurance policy of an Insurance Company, then you can opt for reimbursement for the balance amount from the said insurance company provided your claim covered by the sum insured under the said health insurance policy. The claim-filing process typically remains the same, for all insure
I had taken insurance policy while purchasing a commercial vehicle its recently met with Accident and its under repair from past 40days and i claimed for insurance policy under loss of employment. C ...
Dear Client,
The Motor Vehicles Act, 1988, makes the insurance of motor vehicles compulsory. The owner of every motor vehicle is bound to insure his vehicle against third-party risk. It covers the vehicle for damages against accidents, fire, natural disasters, and theft among others, and also covers any injury to the owner. It also covers any damages and injuries caused to the third party. A personal accident insurance policy provides protection against death, permanent total or partial disabil
We had a insurance back in 2021 .My father got a call from a company One-Day .they said that you will get back your insurance money if you pay 40k when my father paid that they say now you need to pa ...
Dear client,
Section 45 of Insurance Act provides that an insurance policy cannot be avoided after expiry of three years on the basis of mis-statement, or untrue statement, unless insurers are able to establish;
1. That the statement was inaccurate or false;
2. That such statement was on a material matter or that the statement suppressed facts which was material to disclose;
3. That the statement was fraudulently made by the insured;
4. That the insured knew at the time of making the statement t
My dad is travelled out of India as part of a group travel. He fell sick and the entire hospital charges are not covered saying its not a part of the group travel policy
Dear client,
Travel insurance offers protection against financial risks and covers your medical expenses if you fall sick while travelling. But it depends on the insurer and the policy.
Other Responses
I have corporate insurance and have raised post hopitalization claim which was cancelled. Again i have raised the same claim after few days and it got approved. Both the claims are same for same amoun ...
Dear client,
You can file a case against TPA for mentally disturbing you regarding the insurance claim. You can demand them to compensate for this.
My LIC Afent made me take 4 LUC Policies and also give me a table that after 12 years I get 11 Lakhs back but now on maturity they are giving only half the amount. What should I do. Pls advise
Dear Client,
If the LIC Policy is matured without any interruption in payment of regular premium, then the policyholder is eligible for full maturity value as assured in the Policy. Misinformation or misguidance by a licensed/authorized agent to the policyholder in the course of the sale of policy/promotion of insurance business is termed as professional misconduct as per IRDA(Licensing of Insurance Agents) Regulations, 2000. So, you can lodge a complaint against the concerned Agent to the Insur
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