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sachin (GM)     25 April 2020

Genuine accidental medical insurance denied. need expert urgently

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.


 2 Replies

P. Venu (Advocate)     26 April 2020

Have you taken up the issue the Insurance Regulator or Insurance Ombudsman?

sachin (GM)     27 April 2020

Want to have advocate who can do it for me.

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