Mediclaim
Ashwani kumar
(Querist) 21 June 2013
This query is : Resolved
Sir my mediclaim is denied by the insurance co. saying that pre-existing deseases not covered before completion of 4 years while 46 months have been completed to my policy inception.
My policy was started in march 2009
my pre desease was existed in Feb 2009.
I took the policy which was covering all pre existing deseases from day 1(for age below 35 yr) according to the proposal of the company. That was the reason i did not mention my pre existing deases in the proposal form. In feb 2009 there was internal bleeding in my stomach which was cleared by the doctors through endoscopy. I got again bledding in the month of January 2013 for which i am demanding the claim. Pls help me to overcome the problem of mediclaim
Advocate M.Bhadra
(Expert) 21 June 2013
It is depends the nature of Policy and terms and condition of Policy of which under your Policy Coverage.
Insurance Company(Insurer) are reluctant to provide coverage to people who suffer from pre-existing ailments. This is because such people are more likely to require treatment and thus, present a higher financial risk to insurance companies. There is no way of predicting whether a healthy person will get sick, but an insurance company may well be wary of people who already have health problems. After all, insurance companies are also trying to run profitable businesses.
It is difficult to get health coverage when you have an existing ailment, but not all insurers are alike. Some insurance companies will consider a person's entire medical history when determining pre-existing conditions; others will only look at his/her medical records over the last four years.
Rajendra K Goyal
(Expert) 21 June 2013
The terms and conditions of the insurance policy has to be seen and if these do not cover, the the claim will not be paid.
Raj Kumar Makkad
(Expert) 22 June 2013
Suppression of a material fact from the insurance company while filling the form is nothing but providing false information and thus to get favourable policy from it which is not recognized by law.
ajay sethi
(Expert) 22 June 2013
you have supressed material facts while obtaining medi claim . the insurance company would be justified in refuisn to pay the medicalim amount claimed by you
Sudhir Kumar, Advocate
(Expert) 22 June 2013
