Insurance Cover and COVID 19

Hello, As per the information you have mentioned it is advisable to you reach out to your insurance company .

Respected sir/ma'am, Kindly look into the case of Religare Health Ins. Co. Ltd. vs Harwant Singh And Another on 8 February, 2021. You can file an application in the STATE CONSUMER DISPUTES REDRESSAL COMMISSION Section 19 of the General Insurance Business (Nationalization) Act, 1972 states that it shall be the duty of every Insurance Company to carry on general insurance business so as to develop it to the best advantage of the community. The denial of medical expenses reimbursement is utterly arbitrary on the ground that diseases, in question, were pre-existing disease. It is mere an excuse to escape liability and is not bona fide intention of the insurance company. Fairness and non-arbitrariness are considered as two immutable pillars supporting the equity principle, an unshakable threshold of State and public behavior. Any policy in the realm of insurance company should be informed, fair and non-arbitrary. When the insurance policy has exclusions/conditions to repudiate the claim or limit the liability, the same must be specifically brought to the notice of the insured and are required to be got signed to show that such exclusions and conditions have been brought to his/her notice. 22. The need for interpreting a contract always arises in two situations, (i) when a gap is needed to be filled in the contract and (ii) an ambiguity is needed to be resolved in the contract, then to find out correct intention of the contract, spirit behind it is required to be considered. Normally, the insurance policy is a contract of adhesion in which other party is left with hardly any bargaining power as compared to the insurer. Insurance contracts are standard form contracts and are drafted by the insurance company and as such, insurance company is at higher footing than the insured. The benefit of such clause, as exclusion clause, would go to the insured unless the same is explained in clear terms by the insurer. In such circumstances, the tribunal would be more oriented towards the interpretation which goes against the party who has inserted/drafted the disputed clause in the agreement/contract. The adjudicating authority is required to look into whether the intention of the party is to exclude or limit liability has been appropriately explained to the other party or not. This Commission while interpreting insurance agreement is to honour the intention of the parties, who have signed the agreement. Even if the agreement had general exclusion/condition for misrepresentation still fraudulent misrepresentation and non-disclosure may not be there. The innocent and negligent misrepresentations are to be ignored.

No the concerned insurance company has no legal rights to deprive your car from its own damage insurance.

Hey, Scrutinising the above clause the medical insurance company is well under the scope to reject your plea for compensation of your medical expense but you can try reaching out to the an explain your situation or even contact insurance ombudsman for your claim. If you find my answer useful please rate my answer. Thank you

Dear Sir, As per my experience Ombudsman always in the good books of corporates and there is no guaranty that you will get justice from that office unless you establish your case 100% prima facie. It is better to approach Consumer Court after case is disposed by Ombudsman. Rate me Five Star*