cpc

genuine accidental medical insurance denied. need expert


I had taken a Health Insurance policy  on 31 march 2020. I fell ill on 8 April 2020.

I had severe pain in stomach, vomiting and Blocked Urine and was Hospitalised for about 15 days. I informed the Insurance company when I was shifted from ICU to private Room, but they misinformed me that the policy covers only Road Accidents after 24 hours and Other pre-existing  Disease are covered after 2 years and denied to entertain claim. However, Policy document states Clearly that the Accident is covered after 24 hours of Policy activation.

The act of my sudden hospitalization, because of  Injury due to infection entering the body through food, drink or any other means; is an accident as per the definition of Accident.

An accident is an occurrence or an event which happens by chance, without intention or design and  is unforeseen and unexpected and takes place without one’s foresight or expectation; It can only be said that it is not an accident if the outcome/ result is reasonably foreseeable, and that  it need not have been the inevitable consequence of the insured's actions.

Foreign Courts allow recovery so long as the "result" was unexpected and unforeseen. In these cases the courts usually apply a foreseeability test, where the issue is whether the insured's death or injury was a natural and probable consequence of his actions and the injury or it was foreseeable". Eg : (ptomaine poisoning or acute indigestion after eating canned beans; court said insured intended to eat nourishing food, but instead  ate tainted food; thus means was accidental).

Kindly provide me some Case Laws/ Judgments in India for Reference and if any Expert Advocate can take up my matter kindly provide your Contact details.  I need Urgent Expert advise to proceed in matter.  I am contactable at 8802229962. Kindly guide me further cource of action.

 
Reply   
 

Greetings!

Thank you for your question.

You can refer the following article to know the remedies available for realizing insurance claims-

https://www.lawyersclubindia.com/articles/Remedies-available-for-realizing-insurance-claims-11209.asp

Hope the article answers your question.

Regards,

Karishma Yadav

 
Reply   
 


LEAVE A REPLY


    

Your are not logged in . Please login to post replies

Click here to Login / Register  


 

  Search Forum








×

  LAWyersclubindia Menu

IPC Grand Course     |    x