check claim status of religare health insurance
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| check claim status of religare health insurance |
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religare health insurance claim status
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Religare Health Insurance Company Limited was fined Rs 91,000 on the complaint of a Zirakpur resident, Vipul Jain.
As per the complaint, Jain had subscribed a cashless health insurance policy in November 2015 and got it renewed from November 16, 2016, to November 15 last year. Under the said policy, the wife and son of the complainant were also covered with a sum of Rs 5 lakh.
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Jain felt pain in abdomen and on check-up and endoscopy test on January 7 last year, a stone was found in his gall bladder.
The matter was reported to the company, whose representative visited the complainant and noted down that he is suffering from bronchial asthma since childhood and had been using inhaler for the same. However, the representative assured the complainant that he would be entitled to claim benefits. Despite this, the pre-approval was rejected by the firm.
check claim status of religare health insurance
The complainant was admitted to a private hospital on January 24, 2017, for a surgery for removal of stone and discharged the next day after paying the expenses.
Thereafter, a claim was filed with the firm but the latter rejected it on the grounds of non-disclosure of material facts/pre-existing ailments at the time of proposal. The complainant stated that bronchial asthma is not a persistent problem with the complainant and he rarely used the inhaler; once or twice in a year.
check claim status of religare health insurance
In the complaint, it was stated that the representative of the firm misguided the complainant and pressured him to give in writing that he had been using inhaler since childhood. It was also submitted that bronchial asthma and the use of inhaler and surgery of gall bladder had no co-relation in any manner nor bronchial asthma was the reason of development of stone in gall bladder.
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The firm, in its reply, stated that the claim was rejected for non-disclosure of pre-existing ailment while proposing for the policy as per terms and conditions thereof. After perusal of medical documents submitted by the complainant and investigation, it was observed that he had a history of bronchial asthma since childhood and used inhaler for the same and is suffering from cholelithiasis since May 2015, which was not disclosed by the complainant while proposing for the policy and as such breached the principle of utmost good faith.
check claim status of religare health insurance
The forum observed that gall stones tend to be asymptomatic. “People having stones in their body did not have an iota of feeling of their presence till the same is detected by way of medical investigations/X-ray/scan etc.”, reads the judgment.
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The forum added that there is no intentional or wilful suppression of any fact by the complainant, prejudicial to the terms and conditions of the policy. The forum thus ordered Religare to repay an amount of Rs 76, 709, along with compensatory cost of Rs 10,000 and litigation cost of Rs 5,000, to the complainant.
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Buying health insurance can double up as your emergency financial fund while preparing you formical contingencies. A group health plan may or may not be covered. The sum insured limit in a group plan may not also be sufficient for all medical expenses incurred.
