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

 

 

 
Reply   
 

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.

 
Reply   
 



HI,

 

I have already approached Grevice Redressal of the company but chances are slim as this is monoply of the company itself to reject claims

 
Reply   
 
Advocate IPR Associate

nothing new Max Bupa has cheated many of my clients and state commission is taking action against them. You can join it and file complaint.

 

 

Adv.Yashwardhan

9711787139

 
Reply   
 

Thank You Adv.Yashwardhan Tiwari for your time & advice,

Can you please provide more details like where to file the complaint & how much time will it take to get the claim amount,

In my first claim also compnay has made false alligations about missing document further when i highlighted they corrected it,

Since Insurance is a matter where decisions need to be taken keeping in view of future,

I believe a long term stategy need to be made either by irda etc, because for every single claim one cannot run from pillar to post

I m looking for expertise /advice with details keeping in view time & money 

 

 
Reply   
 

HI,

 

Wat will be the expense for filiing complaint/suit ?

 
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Advocate IPR Associate

Being member of lawyers club you will not be charge but for documentation and other  expenses can tell as per your case. For detail call on 9711787139

 

 

Thanks,

Adv.Yashwardhan

 
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