You must be paying some 10000-15000 or more as your insurance premium every year and imagine when you need that policy amount the company reject your claim. This is what most of the companies are doing because most of us don’t even know our rights and responsibilities as policy holders.
In this article I am going to tell you some of your rights along with your responsibilities as policy holder.
1. DOCUMENTATION: While taking insurance policy you must read all the terms and conditions mentioned in it as it clarifies all the points of friction. Also at the time of filing claim you must ensure that you are submitting diagnostic reports, discharge summary, prescription of post hospitalization period, along with bills from the hospital.
2. INTIMATE INSURER IMMEDIATELY: Most of the insurers ask policyholders to inform them about the hospitalization within seven days of being admitted. You may be allowed to submit the required documents later, but the company could insist on being alerted during this time frame. Sometimes due to medical emergency policyholder may not get time to inform the insurer and if insurer reject such claims stating the delay in intimation. Then you can fall back on circular issued by IRDA last year. According to IRDA guidelines, companies are legally bound to admit genuine claims even if there has been a delay in claim submission.
3. HANDLING CLAIMS UNDER MULTIPLE POLICIES: All health insurance policies contain a contribution clause which states that if you have two similar policies, the admissible claim will be split in the ratio of their sum insured. But in this case policyholder has to intimate both the insurers and if you are making a claim for reimbursement both the companies would be requiring original documents. But if the IRDA’s draft circular is finalised, there will be no scope for dispute as policyholder will be able to choose the insurer they wish to claim the money from.