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.
New Delhi: One such story is of Ramchandra Saklal, an elderly man from Bangalore. He had taken health insurance of Rs 5 lakh. When his son got corona, the company refused to give him the claim and he had to pay the hospital bill from his own pocket.
Insurance companies rejected claims
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, 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.
Claim amount should be received within 30 days
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 a complaint can be made to the Insurance Ombudsman and the solution can be found. If you are not satisfied with the action taken there, then you can go to the High Court.
Keep these things in mind in health insurance
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.
What to do when claim is rejected
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 in 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.
Complain to the Insurance Ombudsman
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.
