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Undersigned had taken a Max Bupa medical license Policy for a cover of Rs.30 lacs in the year 2016 p
08-Sep-2023 (In Consumer Court Law)
Undersigned had taken a Max Bupa medical license Policy for a cover of Rs.30 lacs in the year 2016 prior to retirement. Had to undergo a minor surgery on 13th July '2019 and applied for cashless treatment. This was denied by Max Bupa stating that I had suppressed an information of having undergone a surgery for acoustic neuroma in 2004. I contested it was 15 years ago and that I had fully recovered post surgery as certified by medical specialists. Subsequently I have been undergoing regular annual medical checks and maintaining a healthy life. Further both my family Doctor as well as the surgeon who operated me recently in July '2019 certified that the present surgery has absolutely no correlation to my 2004 surgery. In spite of all my explanations, Max Bupa did not approve my claim. I'm left with no option but to take up the matter legally. Kindly review and advise
yes, you can take the matter legally and approach the district consumer commission for relief. as you have stated that the surgeon has certified that your previous surgery has nothing to do with the present one, therefore in this case the insurance company is liable to pay you the amount.
kindly contact us for further details
kindly contact us for further details
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Adv. Prashant Chandra
Lucknow | 200+ Answers
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you can file a complaint before district consumer forum and seek legal remedies. it is good matter to contest and winnable! Trust you have sent legal notice to the said insurance company, if no. pls send the same, demanding the medical expenses , incurred by you , along with the interest and compensation for mental harassment. regards
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Adv. Nidhi Das
Noida | 25+ Answers
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Dear sir, It is very unfortunate that one has to run from pillar to post for their own what they deserve. you have mentioned that you had surgery in July 2019, And wish good health ahead. As you had mentioned that there is no link whatsoever between the two surgeries of 2004 and 2019, the same has been by your Family doctor as well as you're treating surgeon. Therefore there is no question that the insurance company that is Max BUPA, can deny your claim mainly on this ground. It is a breach of trust you definitely reserve legal remedy recourse. You may send your documents over an email and can discuss further.
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Adv. Prashant Vaxish
Delhi | 400+ Answers
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