Saurav (Self) 17 February 2016

Max bupa healh insurance claim denied

Dear All,

Need help/Expertise,

Sub: MAX BUPA HEALH INSURANCE CLAIM DENIED

I have purchased max bax healh Insurance policy in June/2011 for 2 lac added name of my wife in June/2014 renewed on time always,

Now my wife suffering from Typhod/Entric fever was admitted to hospital in 22/dec/2015 the same was intimated to insurance company for appoval to make claim since it was a not tie up hospital,

Now my claim has been denied by the company e mail below

we feel sorry in informing you that your claim # submitted on 15/01/2016 has been denied as per policy terms & conditions. During the verification done by us, gross discrepancies & misrepresentation of facts were noted in hospital documents & Insured statement, hence as per policy clause 5(e), claim merits repudiation.

We apologize for our incapacity to admit the claim and regret the inconvenience caused to you.

My claim is 100% Genuine & True with all documents now this seems a regular practice by Insunce companies to deny claims on one pretext or another.. I m ready to fight for Justice pls provide the expertise/advice for future course of action against company

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6 Replies

Amit Bhandari (Service) 18 February 2016

To be sure that the claim is wrongly denied, you will need to check the policy exclusions applicable to your wife by reading the policy document carefully.

Obtain original/certified copies of medical records. If sure, raise the dispute in writing with customer care, then grievance redressal officer and then ombudsman, in stages.

If claim value is huge, even consider filing a suit in Consumer forum.