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Religare declined my medical claim what can I do
04-Jun-2023 (In Insurance Law)
Religare not giving my 6.4 lakhs claim on the grounds that it was pre existing and that I didn't disclose my hypertension n diabetes. I had lung infection and was operated at Max Saket delhi I purchased the policy in December 2015 thru indusind bank. They came to my home to sell this policy and asked me to just sign the form and rest they would fill. I hv hypertension for last 10-15 years. But re diabetes i was once diagnosed with borderline sugar in 2012. The doctor advised that i just manage my diet but when i told him that I travel a lot then for precaution he advised medicine for some
Sir the case is a fit case for claiming the insurance amount due from the company. I have handled a lot of cases of similar nature where the insurance company rejects the claim on the basis of some technical discrepancies. The insurance companies bank on the fact that many of the claimants do not approach the consumer forums for enforcement of their rights and they get away from paying the insurance.
However, these cases are relating to a dispute between a consumer and insurance company and therefore there is no need to approach the civil courts or district courts for the same. A special forum for fast and speedy redressal has been made called the consumer disputes redressal forums which are present in every district and state and the procedure for getting recovery from them is simple and less time consuming.
Also the view of the National consumer disputes redressal Commission and other consumer forums is in favor of the claimant and if the bona fide is clearly shown then the insurance companies are ordered to remit the insurance amount and in most cases cost of litigation is also given to the complainants and the same does not take a long time.
However the case files need to be examined carefully to see what are the reasons for the repudiation of the claim and then annalysed with the case laws.
Even sending a proper legal notice may make the company realize that you are ready and willing to take legal action and may make the company owe up its debts.
Sending a notice to the company regarding the refund of the amount of insurance and thereafter filing the complaint before the appropriate forum at the earliest can insure that your payment is received from the company.
However, these cases are relating to a dispute between a consumer and insurance company and therefore there is no need to approach the civil courts or district courts for the same. A special forum for fast and speedy redressal has been made called the consumer disputes redressal forums which are present in every district and state and the procedure for getting recovery from them is simple and less time consuming.
Also the view of the National consumer disputes redressal Commission and other consumer forums is in favor of the claimant and if the bona fide is clearly shown then the insurance companies are ordered to remit the insurance amount and in most cases cost of litigation is also given to the complainants and the same does not take a long time.
However the case files need to be examined carefully to see what are the reasons for the repudiation of the claim and then annalysed with the case laws.
Even sending a proper legal notice may make the company realize that you are ready and willing to take legal action and may make the company owe up its debts.
Sending a notice to the company regarding the refund of the amount of insurance and thereafter filing the complaint before the appropriate forum at the earliest can insure that your payment is received from the company.
Helpful?
38+
38+
Adv. Aditya Gupta
Delhi | 100+ Answers
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You have to established that the present mediclaim is not caused to the hypertension and diabetes. And you have also to be established that the hypertension and diabetes is not relevant to repudiation of the grounds pre-existing disease
Helpful?
26+
26+
Adv. Harsh Kumar Gautam
Delhi | 100+ Answers
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