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Service in the interest of Justice

Company Refusing to Pay Health Insurance? Remedy is with Consumer Court

After the announcement of National Health Insurance Scheme by Central Government, the market of Health Insurance is definitely soaring.  Just see the potential of Health Insurance with an estimated size of Rs 5859.7 crore in FY 16-17 to Rs 21, 904 crore by FY 21-22 reports Fintelekt, a specialist research and consulting firm. For opposition though it is a trick to lure for 2019 but consumers can't be taken for a ride and that's why we have consumer courts across the cities in India.

The popular health insurance companies in India are:

1. Apollo Munich Health Insurance Company Limited

2. Star Health and Allied insurance Co Ltd.

3. Future Generali India Insurance Company Ltd

4. Bajaj Allianz General Insurance Co Ltd

5. Cigna TTK

6. National Insurance Co Ltd

7. Iffco Tokio General Insurance Co Ltd

8 The New India Assurance Co Ltd

9. The Oriental Insurance Co. Ltd

10. Reliance General Insurance Co Ltd

11. United India Insurance Co Ltd

12. Royal Sundaram Alliance Insurance Co Ltd

13. Tata AIG General Insurance Co. Ltd.

14. Cholamandalam MS General Insurance Co Ltd

15. HDFC ERGO General Insurance Co Ltd

16. Universal Sompo General Insurance Co Ltd

17. Bharti AXA General Insurance Co Ltd

18. SBI General Insurance Company Ltd

19. Raheja QBE General Insurance Co Ltd

20. MAX Bupa Health Insurance Company Ltd

21. L & T General Insurance Co Ltd

22. Religare Health Insurance Co Ltd

23. Liberty Videocon General Insurance

24. Export Credit Guarantee Corporation of India Ltd. (ECGC)

25. Agriculture Insurance Co. of India Ltd.

26. Shriram General Insurance Company

27. Magma HDI General Insurance Company Limited


Also Read- Legal Notice Before Consumer Complaint

In most of the refusal of health insurance cases the prime reason is that there had been a non disclosure of pre-existing illness /medical conditions on the part of the insured. 

Once in the declaration form the anomaly is founded your health insurance policy can be cancelled and premium paid can be forfeited. Also Health Insurance companies as a measure can also repudiate the claim on this ground solely.  


Also Read- Consumer Court- A quick guide for Tricity.

It is expected from consumer to disclose all pre-existing disease at the time of filling up the proposal form .

In most of the cases Insurance company do undergo a full fledged medical test of insured before issuing a health insurance policy but afterwards they don't acknowledge this fact and refuse claim on account of non-disclosure which is not acceptable by consumers who pay from their hard earned money premium for health insurance.


Also Read- How to Make Complaint under RERA

In a recent decision of Chandigarh Consumer Forum, Max Bupa Health Insurance is directed to pay Rs 7,00, 023 to complainant along with interest of 9% per annum from the date of its repudiation . Further 75 k was awarded for causing mental agony and physical harassment to the complainant,  to pay cost of litigation to the tune of Rs 33k to the complainant. 

You don’t have to worry if your insurance claim is even rejected afterwards since it can be challenged in State Commission via Appeal and if any injustice is done, the path to social justice would be corrected. Consumers pay for health insurance only to get assurance of being helped in rainy or better would be ill days where they can’t afford to look after themselves. It can be a matter of life and death for some. Timely relief is what is sought by consumers and if this is not done in time, grave injustice is done.

Your health insurance policy may have arbitration clause but it won’t help you stop approaching consumer courts since it is a supplementary remedy. Though Health insurance companies may have their own ombudsman to settle claims and they have to give resolution within a specified period which can be 30/60/90 days or even more but fixed. You may also communicate to highest authority in loop with your communication.

If you too are in similar situation and your health insurance or any insurance claim is being denied, just dial 99888-17966 for any assistance. LegalSeva will be surely at assistance.

Say no to injustice and get your Insurance Company pay for a denied claim plus litigation costs. District Consumer Redressal Forum Chandigarh Panchkula Mohal and State Consumer Redressal Commission Chandigarh Panchkula Mohali

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