Mediclaim policy
N.Gopalakrishnan
(Querist) 03 August 2013
This query is : Resolved
Respected Sir,
I am having individual health guard policy with a leading insurance co. In this connection two months back my son met with an accident and hospitalized, treatment given for his injuries under cash less facility, during that accident his 3 teeth were broken partially and jaw bone also fractured. At the time of treatment dentist told me that the crowning job can be done only if the bone set successfully now he is okay and he is ready for crowning job in the meanwhile I contacted the insurance company about to know the procedures for claim they told that at the time of accident we settled all bills to the hospital and the dental treatment charges won't be paid so far, but I found in their policy documents that "dental treatment or surgery of any kind unless as a result of accidental bodily injury to natural teeth and also requiring hospitalization. We will not pay" in this regard I want to answer for 2 questions
1) If I approach consumer forum can I get solution
2) In case the consumer forum will order to the insurance company for reimbursement the insurance company can deny to renewal my policy in future?
I totally confused in this matter I humbly request thee experts to advise me what to do or don't
ajay sethi
(Expert) 04 August 2013
it is necessary to go through the terms of policy to advise .get the treatment done . file claim . let insurance company reject the claim then file complaint before consumer forum for deficiency in service
Adv Archana Deshmukh
(Expert) 04 August 2013
Yes, go thru the terms and conditions and file the claim. Consult a local lawyer with the policy and approach the consumer forum if the company does not pay.
Rajendra K Goyal
(Expert) 04 August 2013
Agree with the advise of Expert ajay sethi ji and Expert Adv Archana ji, nothing more to add.
R.K Nanda
(Expert) 04 August 2013
no more to add.
N.Gopalakrishnan
(Querist) 06 August 2013
Thanks to experts the 2nd question was not answered whether the insurance co have the rights to refuse my renewal if i approach the consumer forum
Rajendra K Goyal
(Expert) 08 August 2013
Approaching consumer forum and renewal are different and are not connected with each other.
