Health insurance claims: How to ensure fair grievance redressal
5 days, 23 hours ago

Health insurance claims: How to ensure fair grievance redressal

Live Mint  

My health insurance company has rejected my claim because I am unable to furnish internal hospital papers. —Name withheld on request If your insurance claim has been rejected due to lack of documentation, it’s essential to understand your rights under the latest guidelines from the Insurance Regulatory and Development Authority of India. Insurers must assist policyholders in identifying missing documents and guide them to ensure claims can be processed without delay. Also Read: Mistakes people make when porting a health insurance policy If unresolved, escalate to the Insurance Ombudsman for impartial resolution.

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History of this topic

How to ensure fair grievance redressal for health insurance claims? Know here
6 days, 10 hours ago

How to ensure fair grievance redressal for health insurance claims? Know here

India TV News  

Being denied a health insurance claim due to lack of documentation can be frustrating, but recent guidelines from the Insurance Regulatory and Development Authority of India aim to address the issue. Simplified documentation Insurers must provide a standardised review of documentation requirements at the time the policy is issued. Written explanation of rejections If the claim is denied, insurers must …

The US’ angst over health insurance: Lessons for India
2 weeks, 2 days ago

The US’ angst over health insurance: Lessons for India

Live Mint  

The recent murder of the head of a prominent health insurer in the US, allegedly fuelled by resentment toward the industry's practices, has cast a harsh spotlight on claims policies that have left many policyholders dissatisfied. In 2021-22, health insurance surpassed motor insurance to become the largest segment by premiums among Indian non-life insurers. For instance, Star Health, the second-largest …

Denial Of Insurance Claim Is Justified In Case Of Breach Of Insurance Contract By The Insured Person: Delhi State Commission
1 month, 1 week ago

Denial Of Insurance Claim Is Justified In Case Of Breach Of Insurance Contract By The Insured Person: Delhi State Commission

Live Law  

Delhi State Consumer Disputes Redressal Commission ruled that denial of insurance claim by “United India Assurance Co. ltd.” is valid where the insured person violates the terms of insurance policy. A coram of President Sangita Dhingra Sehgal and Judicial member Pinki held that non-submission of requisite and essential documents,as per the terms of policy, by the Complainant for due assessment …

Ernakulam District Commission - Internal Dispute Mechanism Under MEDISEP Scheme Doesn't Bar Aggrieved Persons From Approaching Commission
1 month, 4 weeks ago

Ernakulam District Commission - Internal Dispute Mechanism Under MEDISEP Scheme Doesn't Bar Aggrieved Persons From Approaching Commission

Live Law  

The District Consumer Disputes Redressal Commission, Ernakulam bench consisting of D.B. held that the existence of an internal grievance redressal mechanism under the Medical Insurance Scheme for State Employees and Pensioners does not exclude the Consumer Commission from entertaining the complaint. Background Facts Oriental Insurance argued that the complainant has not exhausted the grievance redressal mechanism provided under the Medical …

Himachal Pradesh State Commission Holds United India Insurance Co. Liable For Wrongful Repudiation Of Valid Claim
3 months, 2 weeks ago

Himachal Pradesh State Commission Holds United India Insurance Co. Liable For Wrongful Repudiation Of Valid Claim

Live Law  

The State Consumer Disputes Redressal Commission, Himachal Pradesh bench of Justice Inder Singh Mehta held 'United India Insurance Company Limited' liable for wrongful repudiation of a medical claim based on erroneous interpretation of the policy's clauses. Observations of the State Commission: The State Commission observed the condition stated by the Insurance Company for repudiating the claim, was not applicable to …

No Proof Of Pre-Existing Disease, Kangra District Commission Holds Star Health And Allied Insurance Co Liable For Wrongful Repudiation
6 months, 3 weeks ago

No Proof Of Pre-Existing Disease, Kangra District Commission Holds Star Health And Allied Insurance Co Liable For Wrongful Repudiation

Live Law  

The District Consumer Disputes Redressal Commission, Kangra bench of Hemanshu Mishra, Arti Sood and Narayan Thakur held Star Health and Allied Insurance Co. Ltd liable for deficiency in services due to its unjustified rejection of a genuine claim. The bench held that the Insurance Company repudiated the claim without conducting a proper investigation or obtaining affidavits from treating doctors regarding …

Rejection Of The Health Insurance Claim Cannot Be Based Solely On Assumption Of Pre-Existing Condition: Delhi State Commission
8 months, 2 weeks ago

Rejection Of The Health Insurance Claim Cannot Be Based Solely On Assumption Of Pre-Existing Condition: Delhi State Commission

Live Law  

Delhi State Consumer Disputes Redressal Commission, headed by Justice Sangita Dhingra Sehgal alongside members Ms. Pinaki and Mr. J.P. Agrawal, held HDFC Insurance liable for deficiency in service over the rejection of a health insurance claim solely on the presence of non-communication of pre-existing conditions. Brief Facts of the Case The complainant's husband applied for an HDFC Life Group Credit …

Ernakulam District Commission Holds Oriental Insurance Liable For Deficiency In Service Due To Non-Disclosure Of Policy Terms During The Signing Of The Contract
9 months, 2 weeks ago

Ernakulam District Commission Holds Oriental Insurance Liable For Deficiency In Service Due To Non-Disclosure Of Policy Terms During The Signing Of The Contract

Live Law  

The Ernakulam District Consumer Disputes Redressal Commission, headed by D.B. Upon visiting the insurer's office and providing details of pre-existing conditions, the complainant requested to port their existing policy, which the insurer agreed to do. Observations by the Commission The Commission observed that the insurer had failed to provide the complainant with the necessary terms and conditions of the policy …

Kerala consumer rights panel holds insurance company, bank accountable for medical claim denial
10 months, 3 weeks ago

Kerala consumer rights panel holds insurance company, bank accountable for medical claim denial

The Hindu  

In a major verdict, the Ernakulam Consumer Disputes Redressal Commission in Kerala has held a general insurance company and a bank that facilitated insurance coverage accountable for denial of medical insurance claim to a customer and directed them to pay a compensation of ₹2.23 lakh. Binu and members V. Ramachandran and Sreevidhia T.N., issued the verdict on a petition filed …

Insurance Claim: Three methods to help you resolve insurance-related issues faster; check details
2 years, 1 month ago

Insurance Claim: Three methods to help you resolve insurance-related issues faster; check details

Firstpost  

Insurance coverages are common among individuals who want to ensure financial security for emergency situations. Policyholder objections are regularly sent to the insurance company, but sometimes the customers don’t receive any desired response from the company officials. Here are some additional methods to resolve insurance policy-related issues: Contact the Grievance Redressal Officer: Every insurance company assigns a Grievance Redressal Officer …

Insurer can't refuse claim by citing existing medical condition once policy issued: Supreme Court
3 years ago

Insurer can't refuse claim by citing existing medical condition once policy issued: Supreme Court

India TV News  

An insurer cannot repudiate a claim by citing an existing medical condition that was disclosed by the insured in the proposal form, once the policy has been issued, the Supreme Court has said. "Once the policy has been issued after assessing the medical condition of the insured, the insurer cannot repudiate the claim by citing an existing medical condition, which …

Insurance firms to comply with mental health Act: HC
3 years, 8 months ago

Insurance firms to comply with mental health Act: HC

The Hindu  

The Delhi High Court on Monday said that insurance companies are liable to give effect to the Mental Healthcare Act 2017 in their policies from the time it came into force in 2018. The High Court’s directions came on a woman’s plea whose claim for reimbursement of costs for treatment of schizophrenia were rejected by the National Insurance Company Ltd …

Delhi High Court Seeks Response From IRDAI On Plea Alleging Failure To Protect Interests Of Policy Holders
3 years, 9 months ago

Delhi High Court Seeks Response From IRDAI On Plea Alleging Failure To Protect Interests Of Policy Holders

Live Law  

The Delhi High Court has sought response from the Insurance Regulatory Development Authority of India on a petition alleging inaction on its part for protecting the interest of various policy holders. Under Section 14 of the IRDAI Act, 1999, the authority is entrusted to protect the interests of policy holders in matters concerning assigning of policy, settlement of insurance claims, …

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