Denial of insurance claim

684 votes

yes. a case was already filed by me and the case is under trail of consumer court south chennai. the insurer has not filed any counter, if the insurer has already allowed the same that would constitute precedent to the present one. eight seven seven eight seven four zero five three four

Advocate Murali Krishnan Sanjeevi LawRato

513 votes

Question: Hi sir,this is selva from chennai.I had taken group mediclaim policy last year,which was given by my corporate.I submitted claim around 2 lakhs for my father's hospitalization with an insurer. The admission is for heart dysfunction, caused by severe heart attack.This dysfunction inturn develops multiple organ dysfunction.But they rejected my claim on the basis of alcoholic history [They rejected by the word(C/o-chronic alcoholic liver disease) it was mentioned in hospital ICP]&they told alcohol intaking disease was excluded in policy] Though my father has the alcoholic history he COMPLETELY stopped it for 10 years(Which was also CLEARLY Mentioned in ICP).[moreover SAME insurer Approved claim for same disease(Chronic alcoholic liver disease)for past 2years(Rs.69000&15000)] can I ask with them for reconsideration of my claim on the basis of 1.as he stopped alcohol for 10years? 2.Basis of previous claim approvals? 3.basis of pre-existing disease(which is opted in my policy).Is it Payable
First go through the policy terms and condition .we can go for consumer court.

LawRato LawRato

818 votes

Hello
You too a insurance policy base on the conditions apply?
You have admitted at that time of alcohol intaking or not
Which hospital admit?
You have sent a any representation to consent policy company?
You're policy rejected to hospital made in reason or not
you have a acknowledgment letter
You're father recent not taking alcohol any medical officer examine and given medical report?
Contact an Advocate
Further details

Advocate S Rasak LawRato