An insurance company can’t deny cover if money is paid but policy is not activated
Category: Insurance
How to Claim Road Accident Compensation As Per M.A.C.T Guidelines
This article written by Anubhav Pandey perceives the Road accidents that happen in a day-to-day life, from a different angle and narrates How a victim can claim for Road Accident Compensation as per M.A.C.T. Guidelines.
What is the process that one should follow to get compensation after facing a road accident?The sight of the accident is very common on Indian roads. Over 400 people were killed in road accidents every day in 2015, government data reveals. The hapless victims are left paralyzed on the street and after by the intricacies involved in legal machinery.
Here is a simplified guide on how one can get compensation if it ever becomes a victim of a road accident.
Compensation to the Victims of Motor Vehicle Accidents
Rapid justice and speedy trial are two eyes of any justice delivery system. The justice delivery system in M.A.C.T (Motor Accident Claims Tribunal cases) is far away from satisfactory. Say, an owner of a brand new Mercedes while returning from his game of hunting crashes his car into a footpath, killing civilians over it.
There are two facets in this circumstance-
- One is the commission of the criminal offense.
- Second is the compensation claim.
What to Do After an Accident?
- A case is registered by the local police on complaining or either they will take cognizance on their own. (Registration of F.I.R). For this-
- One should take pictures of the accident scene or even a video for use as evidence later on. Even just a passer-by can do this and provide the photos or videos to police for support in investigation and delivery of justice.
- They should, however, call the 100 number (police hotline) and inform what the situation is in a clear and calm manner.
- What is said on this call gets recorded and can be used as evidence later on.
- After this, police has to register FIR, investigate and then charge-sheet the accused. After this, the judicial mechanism will set itself into motion.
- Legal intricacies involving demand of proper compensation to be put forward before MACT tribunal.
Who Can Claim Compensation in Motor Accident Cases?
Section 165 (claim for compensation) can be made–
- By the person who has sustained the injury.
- By the owner of the property where death has resulted from the motor accident.
- By all or any of the legal representatives of the deceased.
- By any agent duly authorized by the person injured or all or any of the legal representatives of the deceased, as the case may be.
Suggestive Read: How and when to file claims with Motor accidents claims tribunal?
Jurisdiction: Where Should One Claim Compensation for Motor Accident?
If a man from Calcutta is on a tour to Kanyakumari and gets involved in the motor accident at Kanyakumari then, where should he file a road accident compensation claim? The Procedure requires as follows:
- Every application is to be mad at the option of the claimant, either to the Claims Tribunal who is having jurisdiction over the area in which the accident occurred. (Place Of Accident)
- Or to the Claims Tribunal within the local limits of whose jurisdiction the claimant resides (Nearest Tribunal to Victim) or carries on business.
- Or within the local limits of whose jurisdiction the defendant resides(Nearest Tribunal Where The Accused Resides).[1]
If the Driver Had No Fault in the Motor Accident then, Can the Victim Still Get Road Accident Compensation?
A, as per her mother’s instruction went to a shop for local veggies. First, she looked left then right and then left and then took the zebra crossing. But, while crossing hurriedly, she was hit by a car. Even though there was no fault on either side, what could be the intricacies involved while demanding road accident compensation in this case?
No Fault Liability in Case of Motor Accident for Drivers
Where death or permanent disablement of any person has resulted from an accident arising out of the use of a motor vehicle, the owner of the vehicle or the owners of the vehicles, will be liable to pay road accident compensation in respect of such death or disablement.
In the case of death, the minimum sum to be paid is INR 50,000/- and in the case of disablement, a minimum sum to be paid is INR 25,000/-[2], and this minimum is subject to additional compensation which the tribunal might grant under s 163A.
For a victim, one does not need to prove the negligence of the opposite side, it is assumed. The victim need not be required to plead and establish that the death or permanent disablement in respect of which the claim has been made, was due to any wrongful act, neglect or default of the owner or owners of the vehicle or vehicles concerned or of any other person.
How Much Road Accident Compensation is One Entitled to in Case of Motor Vehicle Accident in India?
Simply put, if a driver is involved in an accident in India and if it caused victim’s death then, a minimum of INR 50,000/- and if permanent disablement is caused then, a minimum of INR 25,000/- must be paid.
A claims tribunal can pay even more after considering the case. The owner of the motor vehicle or the authorized insurer shall be liable to pay in the case of death or permanent disablement due to accident arising out of the use of a motor vehicle under section 163A.
“There can be no doubt that, compensation claimed u/s 140 is governed by the no fault principle”.[3]
Permanent disablement for this purpose means–
- Permanent privation of the sight of either eye or the hearing of either ear or privation of any member or joint.
- Destruction or permanent impairing of the powers of any member or joint.
- Permanent dis-figuration of the head or face.
Third Party Liability in Case of Car Accidents and Insurance Requirement
For instance: ‘A’ purchases a motor vehicle through a Nationalized Bank on 1.10.1993 and the said vehicle is insured for ‘The Period Of One Year’. He sells the vehicle to ‘B’ on 3.11.1993. The Motor Vehicle in the custody of ‘B’ meets with an accident on 6.11.1993 and the name of the owner of the said vehicle is not yet changed in the R.C Book. ‘A’ has not sent an application in the ‘Prescribed Form’ about the Transfer of Motor Vehicles to the Insurance Company immediately.[4]
- Whether the transfer of motor vehicle has to be allowed to put an end to the Insurance Policy automatically or
- Whether the mere transfer of motor vehicle entangles the statutory protection of just compensation amount to the victims.
The driving of an uninsured Motor Vehicles is an offense, requiring punishment for 3 months Or fine of one thousand Rupees under Section 196 of the act.
Moreover, in case of sale of a car or other vehicles, the person selling the motor vehicle shall apply within fourteen days, from the date of transfer, in the prescribed form to the insurer for making necessary changes in regard to the fact of transfer in the certificate of insurance and the policy described in the certificate in his favor and the insurer shall make the necessary changes in the certificate and the policy of insurance in regard to the transfer of insurance.
The transfer of the motor vehicle puts an end to the compulsory insurance policy itself as the application in the ‘prescribed form’ is not sent to the Insurance Company.
Further, the complication arises when the said vehicle is hypothecated by a Nationalized Bank and under such circumstances, the poor victims are shoved to the ‘sea of troubles’ for their inability of getting the compensation amount in time.
Is A Pillion Rider Entitled to Road Accident Compensation in A Case of Two-Wheeler Accident Or A Co-Passenger in Case of Car Accident?
The Supreme Court created a precedent to be followed in cases involving pillion riders and co-passengers.
- The liability of the insurance company in a case of this nature is not extended to a pillion rider or a co-passenger of the motor vehicle unless the requisite amount of premium is paid for covering his/her risk.
- The pillion rider in a two wheeler or a co-passenger in a car is not to be treated as a third party when the accident has taken place owing to the rash and negligent riding of the two-wheeler or car and not on the part of the driver of another vehicle.[5]
It is thus settled that, the liability of the insurance company is not extended to a pillion rider or a co-passenger of the motor vehicle unless the requisite amount of premium is paid for covering this risk.
- The legal obligation cannot be extended to an injury or death of the owner of the vehicle or the pillion rider. Further, the pillion rider on a two-wheeler cannot be treated as a third party when the accident has taken place owing to the rash and negligent riding of the scooter and not on the part of the driver of another vehicle.
Road Accident Compensation in Case Where Both Driver And the Victim Were Negligent
What if victims were also negligent while the driver was also negligent and the accident occurred due to the contributory negligence of both parties?
For example, someone starts driving on a one-way road in the wrong direction while another car is driving in the right direction but, without headlights on. The two collide which results in severe injury to the two wheeler driver. Would he be entitled to any road accident compensation?
- Contributory negligence is when the claimant himself has been negligent and has contributed to the occurrence of the accident. In contributory negligence, the victim himself has contributed and therefore, his compensation gets reduced in proportion to his fault. Thus, if the victim is equally negligent and has contributed to the accident in equal measures, he would get only half the compensation.
- On the other hand, Composite negligence means where the accident occurs due to the negligence of two or more persons but, not the victim. In an accident involving two or more vehicles, where a third party claims damages for loss or injuries, it is said that the road accident compensation is payable in respect of the composite negligence of the drivers of those vehicles.
In such a case, each wrongdoer is jointly and severally liable to the injured for the payment of the entire damages and the injured person has the choice of proceeding against all or any of them.[6]
What Happens in Case of the Accident Caused by an Underage Driver?
Chachu giving keys to his niece and nephew is common in India. But, what would a person do if he is hit by a minor driving a vehicle? In these cases, Insurance company does not provide with road accident compensation on behalf of the insurer and the liability lies on the child’s legal parent or guardian.
Compensation Provided in Motor Vehicle Accident Where Victim is a Child
A child is not the bread earner of the family and hence, the death of a child during a motor vehicle accident involves different intricacies. Along with awarding for pecuniary losses, the court also has to award for future losses. Pain and suffering caused because of the sudden demise of life, the age of the child, while the accident took place, etc has to be factored in.
The apex court formed a point that, while considering such claims, child’s performance in school, the reputation of the school etc. might be taken into consideration.When records show that the children were good in studies and were studying in a reasonably good school [7] then naturally, their future prospect would be presumed to be good and bright. Since they were children, there is no yardstick to measure the loss for future prospects of these children. However, as already noted, they were performing well in studies, the natural consequence was supposed to be a bright future.
What Happens in the Case Where Victim of a Motor Vehicle Accident is a Housewife?
When the victim of an accident is a housewife then the settled law is [8] “for the purpose of awarding compensation to the dependents” some pecuniary estimate has to be made of the services of housewife/mother.
The amount payable to the dependants cannot be diminished on the ground that some other family member can take care of the well-being of the family as the deceased housewife did. In its wisdom, the legislature had, as early as in 1994, fixed the notional income of a non-earning person at Rs.15,000/- per annum and in the case of a spouse, 1/3rd income of the earning/surviving spouse for the purpose of computing the road accident compensation.
Plight of the Victims Due to Ambulance Chaser
The legal profession has its share of ‘ambulance chasers,’ as they are called in some of the western countries. These are the lawyers who make a living out of the motor vehicle accidents. It is a well-oiled network where the lawyers and the police act in close co-ordination[9].
It is woeful to note that the moment an accident takes place, the Police Inspector concerned gets in touch with the particular network of lawyers. Such lawyers swoop on the hapless victims who are in a confused state and even when the dead body is placed for funeral ceremony or the said ceremony is just over, they allure the said victims with promises of getting the huge road accident compensation amount, without spending any amount of money from their purse even for the stamps in the M.A.C.T petitions.
The poor overwhelmed accident victims believe the promises of such lawyers and entrust the briefs to them by signing the blank papers, including stamped papers and withdrawal slips, in advance without the knowledge of the victims in such cases. Further, their counsels themselves enter into the compromise with the Insurance company as to the compensation amount, even without the consent or knowledge of the victims.
Compensation Provided to the Victim in Hit And Run Cases
In Salman Khan’s case– “The verdict doesn’t really affect us in any way,” Mohammad Kaleem, 35, tells The Indian Express from Sultanpur. “How do we benefit if he is sent to jail? I received Rs 1.5 lakh in compensation but, it was spent on my treatment. We’re poor and the jail term won’t fill our stomachs.”
Section 163 A of M.V. Act deals with the situations involving hit and run cases.After the accident, either the victim or his legal representative can file an application to the Claim Officer of the taluka where the jurisdiction lies. After the proper inquiry and the procedure involving submission of post mortem certificate or injury certificate, road accident compensation may be provided from the solatium fund created by the government within 15 days.
Time Limit for Filing of Complaint Before the Tribunal for Motor Vehicle Accidents in India
There is no time limitation for filing road accident compensation claims before the tribunal in respect of any accident. Parliament realized the grave injustice and injury which was being caused to the heirs and legal representatives of the victims, who died in accidents, by rejecting their claim petitions only on the ground of limitation. [10]
Who is to Compensate in Cases of an Accident of Bus Passengers in India
Situations, where passengers get down of bus even before the bus stops or in the traffic jams, in such or similar circumstances, the conductor and the driver must be careful and they have a duty towards the passengers in not allowing them to be injured in any way. [11]
A lady passenger was getting down the bus and her one foot was on the footboard and other on the road, when the conductor gave the whistle and the driver moved the bus and she was knocked down and was dragged along by the body of the bus and sustained fatal injuries. It is the crew of the bus who is negligent for the accident which occurs at a place where the bus is to stop, though it is not a bus stop.
“But the fundamental duty of both the driver as well as the conductor is to verify specifically, whether any passengers is getting into the bus or is getting down from the bus, before actually the bus is moved from the bus stop where it is stopped, irrespective of the fact whether that place or stopping is a bus stop or not”.[12]
The onus to compensate the victim lies on the owner of the bus or the insurance company of the bus owner.
Factors Affecting the Claim for Compensation of Motor Vehicle Accident in India
While awarding a claim for compensation, the court looks for the following factors-[13]
- All the parties are heard (including the insurer). Tribunal decides the case on merits (Example on above as, whether there was a third party risk involved or not, whether there was composite or contributory negligence or not etc.)
- When a road accident compensation is awarded, the person who is required to pay that amount has to pay it within 30 days of announcing of orders.
- Even simple interest is applied on the amount from the date of making of claims.[14] When the person required to pay the road accident compensation is willingly or otherwise not paying the amount, the tribunal can order Collector to recover the money as it happens in cases of arrears of land revenue.[15]
That’s all about “How can one claim for Road Accident Compensation as per M.A.C.T. Guidelines”. Comment Below your views. And, Don’t forget to share the article.
References:
[1] Section 166,(3)(2) of Motor Vehicle Act,1988.
[2] Section 140, Motor Vehicle Act,1988
[3] (National Insurance company ltd v Sinitha and ors, 2012 2 scc 356
[4] Sri. C. Lakshmi Narain, Claims for Compensation Before Motor Accidents Claims Tribunals,(1998) 1 LW (JS) 17
[5] Oriental Insurance Co. Ltd. vs. Sudhakaran K.V.(2008) 7 SCC 428.
[6] Andhra Pradesh Road Transport Corporation vs. K. Hemlatha,AIR 2008 SC 2851.
[7] General Manager, Kerala S. R. T. C. v. Susamma Thomas, (1994) 2 SCC 176
[8] Arun Kumar Agarwal vs. National Insurance Company AIR 2010 SC 3426
[9] LEGAL FILE’ in the Sunday Magazine, ‘Hindu’ Dated: 27.12.1992)
[10] 1994 Amendment of the Motor Vehicles Act, 1988 as
[11] M.Jaganath V. Pallavan Transport Corporation Ltd,1996 SCC Online Mad 524
[12] Venkataswami Motor Service v. C.K Chinnaswamy, 1989 ACJ 371
[13] S 168, Motor Vehicle Act, 1988.
[14] S 171, Motor Vehicle Act, 1988.
[15] S 174, Motor Vehicle Act, 1988.
Death by Mosquito Bite is Accidental Death
“Death of Policyholder due to Malaria after Mosquito Bite is an accidental death and hence Insurance Company is liable to pay the sum assured.”
In an interesting Case of National Insurance Co. Ltd. V/s Mosumi Bhattacharjee, (R.P. No.1270/2016), a question came before the National Commission to decide whether death of a Policy holder due to Malaria after a mosquito bite can be termed as accidental Death ?
Facts in short.
1. Late Mr. Debashish Bhatacharjee, the husband of the Complainant took the home loan from Bank of Baroda and along with it, he also availed facility of Term insurance like policy by name “Bank of Baroda Loan Suraksha Vima”, issued by the National Insurance Co. Incase of an accidental death, the policy amount was to be paid to the claimants
2. During the subsistence of the Policy, the Policy holder died due to Malaria and hence his legal heirs (LRs) applied to the Insurance Company fir getting the sum assured.
3. But the Insurance Company turned down the claim on the ground that Malaria itself is a disease and not an accident. Hence the LRs filed the complaint before the District consumer forum, which was allowed in their favour. Hence the Insurance Company filed the appeal in state commission, which was also rejected and hence the matter came to national Commission.
Held :
1. The National Commission upheld both the judgments of lower foras and observed that the Policy does not define the Term “Accident”. It relied upon the definition of Accident given in oxford dictionary, wherein it is defined as “An Accident is something that happens unexpectedly and not planned in advance and causes injury”.
2. Thus no one can predict about the mosquito bite and it can happen anywhere and anytime, like an accident. It relied upon the earlier judgment of Matbarsingh V/s Oriental Insurance Co.) wherein it has been held that Snake-bite, dog-bite, frost-bite are also accidents. It rejected the argument of the National Insurance company that Malaria itself is a disease and not an accident.
A) I feel this is an important judgment. Few days back, at least a person in every family was suffering from Dengue / chikungunya and Malaria. Few patients were succumbed to death due to such diseases.This judgment may be helpful to such families. Obviously terms of Policy, if any, will play an important role.
B) This decision also underlines the importance of having Term Insurance like policies. Consult an expert in this field.
https://www.casemine.com/judgement/in/590a32924a932663936ff762
Income Tax return required for Road Accidental Death Compensation
Accidental Death & Compensation:
(Income Tax Return Required)
If a person has an accidental death and the person was filing income tax returns for the last three years, then the government is obliged to give ten times the average annual income of the last three years to that person’s family.
Yes, you will be surprised by this, but this is right and it is Government rule. For example, if someone’s annual income is 4 lakh 5 lakhs and 6 lakhs in the first, second and third years respectively, its average income is ten times of five lakhs.. means five million rupees, family of that person is entitled to receive from the Government.
In the absence of much information, people do not take this claim with the Government.
If any return is missing, mainly last three years, this could lower the claim amount or even no claim because court takes ITR as only evidence. NO wealth record, FD’s; business etc. is given that much importance as compared to ITR in the eyes of law.
Many a time, people do not file ITRs regularly..or it will be taken lightly..
Due to lack of information the family receives no economic benefits.
Source – forwarded
Section 166 of the Motor act, 1988 (Supreme Court Judgment under Civil/ Appeal No. 9858 of 2013, arising out of SLP (c) No. 1056 of 2008) Dt. 31 Oct. licvaithi
Accidental Death & Compensation:
(Income Tax Return Required)
Insurer must alert client in case of premium default
Case Study: Nagu Gouda worked as assistant teacher at a school under the Karnantaka government’s block education officer (BEO). He took a policy of Rs 1.25 lakh under LIC’s Salary Saving Scheme, which provided that the employer would deduct and remit monthly premium to LIC.
The last premium was remitted in August 2009. Later, Gouda took ill and was on leave without pay. So premium could not be deducted. Gouda died on July 20, 2010. His widow, Seeta, made a claim under the policy, but LIC refused, saying the policy had lapsed due to unpaid premium.
Seeta filed a complaint in the district forum against LIC and the BEO that the employer couldn’t remit premium as Gouda was on leave without pay and Gouda should’ve been told to pay instead of letting the policy lapse. She alleged that failure to intimate Gouda to pay was ‘deficiency in service’.
LIC said Gouda’s premium for last 10 months was not remitted by the BEO or by Gouda. It said the policy had lapsed and the claim was rightly repudiated. LIC sought dismissal of the complaint.
The district forum held LIC and the BEO jointly and severally liable to settle the claim. It ordered payment of the sum assured with accrued bonus and 9% interest.
LIC challenged this order, but its appeal was dismissed by Karnataka State Commission. LIC approached the National Commission and contended that Gouda alone was responsible for failure to remit premium, and that the BEO as employer could not be held liable as Gouda had opted for premature retirement on June 30, 2010. LIC also said that Gouda had given that he would be responsible for consequences of non-payment of premium.
The National Commission observed that LIC and the employer have a duty to inform the employee.
By its order, the National Commission said there was deficiency in service Thus, he ordered holding the employer and LIC jointly liable to settle the claim was upheld.
Conclusion: The employer and LIC have to inform the insured about default in payment of premium under Salary Savings Scheme.
(The author’s e-mail is jehangir.gai.columnist@ outlook.in)
Jehangir B Gai
Insurer must reimburse diabetes patient cost of glucometer test strips under mediclaim
Diabetics, especially those who are insulin dependent, have to monitor their blood sugar before every shot of insulin, to determine its correct dosage.This requires a glucometer and test strips, which are quite costly. Can the insured recover the cost under a mediclaim policy?
Case Study: Purvi Kamlesh Shah and her daughter were covered under a mediclaim policy issued by New India Assurance. The policy was first taken in 2005 and then renewed without any break. However, while renewing the policy with continuity, a fresh proposal form had been obtain in 2008.
During the tenure of the renewed policy from March 13, 2010 to March 12, 2011, Purvi had to be hospitalized on July 13, 2010 due to fluctuating blood glucose levels. After she was discharged on July 16, 2010, she lodged two claims, one for the hospitalization expenses of Rs 55,409 and the other of Rs 7,680 towards medicines. The insurer’s TPA, MD India Healthcare Services settled the claims at Rs 47,931 and Rs 3,680 respectively. The deductions were in respect of expenses incurred on purchase of glucometer strips to check the sugar levels. The reason for disallowance was that these were considered as “nonmedical expenses“, and so were not payable under the policy .
Purvi protested against this disallowance, but New India’s Grievance Cell failed to respond to her representation. She filed a complaint before the South Mumbai Forum through the Consumers Welfare Association and sought a direction to reimburse these expenses along with interest and also claimed compensation and costs.
The TPA as well at the insurer contested the case and claimed that the amount had been correctly computed. They claimed that Purvi was not entitled to dispute the amount after having accepted the claim in full and final satisfaction.
The forum observed that the policy conditions had been changed, so a fresh proposal had been taken in 2008. So the new terms under the revised policy would be applicable, which provided for limiting the claim on the basis of the room category. The forum concluded that there was no deficiency in service and dismissed the complaint. Purvi challenged the order, but her appeal was dismissed by the Maharashtra State Commission. Purvi then questioned the orders in revision. The National Commission noted that various clauses of the policy providing for certain exclusions had been inserted in the Mediclaim Policy (2007). The Commission observed that it was beyond comprehension how any claim for medicines could vary with the room category opted for, as medicines treatment would be the same regardless of the room category .
The Commission pointed out that glucometer strips are essential for a diabetic to monitor blood glucose levels and adopt a medical regime to prevent the consequences of elevated or declined blood sugar levels. So it would be wrong to consider the expense on the test to be nonmedical expenses. The deduction of Rs 9,350 on this pretext was held to be wrong.
The National Commission’s bench comprising of justice D K Jain, along with M Shreesha, held the TPA and the insurance company jointly liable to pay the cost of the test strips amounting to Rs 9,350 with interest at 9% from the date of filing of the complaint. Six weeks time was given for compliance of the order. In addition, costs of Rs10,000 were awarded to Consumers Welfare Association for espousing the cause of the consumer.
(The author is a consumer activist and has won the Govt. of India’s National Youth Award for Consumer Protection. His email is jehangir.gai.columnist@outlook.in)
Jehangir B Gai
ePaper, The Times of India (Bombay), Oct 30 2017, Page 7 :
Burglary Insurance: Absence of Force Will Mean No Burglary Claim
A Supreme Court (SC) judgement on a theft claim filed by a public sector unit in Odisha states, “In the absence of violence or force, the insured cannot claim indemnification against the insurance company. The terms of the policy have to be construed as it is and we cannot add or subtract something. Howsoever liberally we may construe the policy, we cannot take liberalism to the extent of substituting the words which are not intended.” It is based on another 2004 SC judgement. The new SC judgement is clear that the terms of the policy are sacrosanct; it can’t be subjected to interpretation. The liability of the insurer would depend strictly on the policy conditions.
Home insurance, travel insurance, commercial insurance, etc, may cover ‘burglary’ and not ‘theft’. For a layman, both seem to be same. ‘Burglary’ is theft that has to be accompanied by forced entry, violence, or threat of violence. ‘Theft’ may not have a forceful or violent entry to cause a loss to residential or commercial property. It can even be an insider job by an employee or a family member.
Your case may fall under a long list of exclusions, or the semantics of the policy, which differentiates between ‘theft’ and ‘burglary’. Burglary is the criminal offence of breaking into and entering a building illegally for the purpose of committing a crime. On the other hand, theft is the act of stealing; the wrongful taking and carrying away of the personal goods usually without force. If the home insurance policy excludes burglary and covers only theft, then you are at a disadvantage. What about theft or burglary while travelling?
Moneylife had written about the case of Cox & Kings (C&K) tourists being robbed in a bus in Italy which was not covered by the insurer. (Read http://tinyurl.com/hcojgq9). It helps to clarify what is burglary versus theft which is applicable to home as well as travel insurance. While buying travel insurance, customers hardly know what is really covered.
6 Mediclaim Blunders To Avoid
Warning:You may be denied your claim even though you may have done nothing wrong
Financial planners tell customers to buy mediclaim of Rs5 lakh or more, to be covered adequately. While this is, indeed, good advice, planners do not tell customers about the shortcomings in the product itself which can mean that your claim may not be fully paid. Product drawbacks, like room rent limits or procedure sub-limits, can lead to partial claim settlement and reduced compensation claim amounts, about which you can try to get informed from the policy wordings. But what about things which are not defined in the policy but can still render the mediclaim useless? There could be complete rejection of claims, for no fault of yours.
You can only control what you know; but most of us cannot anticipate the various conditions which can lead to claims denial. We are highlighting some of the cases which we came across from Moneylife Foundation Insurance Helpline or emails received from Moneylife readers. Avoid the pitfalls which no financial planner or insurance advisor will tell you about. Nor can these be known from studying the mediclaim policy document.
Mediclaim is not a simple product. It’s not a product you can purchase and forget about. It is a product which will keep you on your toes. Unfortunately, insurance fraud is a reality and insurers’ steps to counter it may adversely impact an innocent policyholder. Read on to avoid blunders that can lead to rejection of claim or, even worse, make your mediclaim policy worthless. There are no easy solutions for some cases and even your best efforts for a fair claim can be met with unfair rejection by insurers.
ASCI upholds complaint against Bajaj Allianz false advertising
Advertising Standards Council of India (ASCI) has upheld a complaint against Bajaj Allianz General Insurance false advertising. One Moneylife reader forwarded e-mailer ad from Bajaj Allianz on car and health insurance with a heading “Ways Your Current Insurance Company Is Ripping You Off”. He was curious to know if the insurer has data to back its claim – e.g. fastest claims servicing, legal advice, accommodation benefits, 30% savings on medicines, eye care, dental care and so on. Making tall claims is a ground for an ASCI complaint. Moreover, other insurers will be watching and also seek a fast track hearing.
Raj Pradhan
Click Here for more
The Truth about New India Assurance’s top-up policy
Newspapers have claimed that New India Assurance’s newly launched top-up policy is the cheapest. These articles assert that you can even do cosmetic surgery and claim the amount over the deductible, for expenses covered by mediclaim. Here is the truth
New India Assurance (NIA) has launched a top-up plan, which is being hailed by few newspapers like the Times of India (ToI) and Economic Times (ET) as the cheapest product available. This is incorrect. The NIA top-up plan is not the cheapest and it is more expensive than super top-up products which are a better option.
The ToI article states – A unique aspect of NIA’s cover is that for the threshold limit to be reached, all hospitalization expenses are taken into account irrespective of whether the expenses would qualify as an insurance claim. This means that the insured can spend Rs5 lakh on a cosmetic surgery (which is not covered under mediclaim) and recover any additional health expense (covered under mediclaim) under the top-up plan. This is absolutely incorrect information. Moneylife wrote about the discrepancies to New India Assurance, but there was no response till the writing of this article. In fact, there is no health insurance product that covers cosmetic surgery.
Click Here for the full story
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