Health insurance is like a security cover for a common middle class family. When this armor does not work on time, then the whole family gets into trouble.
This story of Ramchandra Saklal is not alone. In the era of Corona epidemic, many such stories are coming out. When health insurance companies rejected the claims of patients on the last occasion. At the same time, the hospital managers also put a condition that they will not do cashless treatment on the basis of health insurance. In such a situation, people were forced to get their families treated by taking loans from relatives or other people.
According to experts, any sum insured should be received within 30 days. If this does not happen then there are many levels where it can be complained about. Initially, its complaint can be made in the insurance claim complaint department of the company. If there is no proper answer from there, then the solution can be found by complaining to the Insurance Ombudsman. If you are not satisfied with the action taken there, then you can go to the High Court.
Your health insurance claim should not be rejected in times of trouble. To avoid this, you have to keep some things in mind. First of all, note that while taking insurance, do not give any wrong information. Please provide information about pre-existing diseases. Pay premium on time. Please read the terms and conditions thoroughly. Understand well which diseases are out of coverage.
If despite taking care of all the things, your claim is partially or completely rejected, then first of all put your point in the complaint cell of the insurance company. If you do not get a satisfactory answer within 15 days from there, complain to IRDA. IRDA is the largest regulatory body of the insurance sector in the country. You can also complain on IRDA’s toll free number 155255 or 1800 4254 732. Along with this, e-mail can also be made to IRDA’s complaints@irdai.gov.in.
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If your insurance claim is up to Rs 30 lakh and despite complaint to IRDA nothing happened, then you can approach the Insurance Ombudsman. He tries to mediate between the insured and the insurance company. The Ombudsman can fix the claim amount on the basis of facts. If the insured agrees to the claim amount, then the order is passed and the company has to comply with the same within 15 days. If arbitration does not work out, the Ombudsman can issue a unilateral order and the company has to comply with it within 30 days.
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