Can Myopia be termed as ailment for denial of mediclaim under pre-existence deceases?

Question

I have obtained a mediclaim policy. While opting the policy I have clearly mentioned existance of myopia in the medical necessity column. Insurance company issued me mediclaim policy withoout any conditions of exlusions. Insurance company's denial compelled me to lodge a complaint with Hon. CDRF for redressal for claiming medical expenses with mental agony of Rs. 100000/- with legal expenses of Rs. 20000/-. Hon. CDRF partly allowed my claim and held Ins.com. liable to pay me claim amount with 9% interest with cost of Rs. 5000 towards mental agony and Rs. 2000 for legal charges. Insurance com. subsequently gone in appeal with State Com.. Their appeal dismissed with cost of Rs. 1000/-. Just today only I have received awarded claim. But I am denied interest on the deposit amount which was deposited by Company as required for submitting an appeal. Can any body tell me, whether I conclude with satisfaction of claim or still is there is provision for teaching lessan to Ins. Com.?

Answer 1

You can still ask for the interest on the claim amount if that order is passed in you favor & have been upheld by the State Commission. As far teaching further lesson to this insurance company, you should have mentioned the complete name & all the particulars about this company in this question in this yahoo forum itself & other such forums/places for large people of India to see the real face of this insurance company & whenever any of their agent approached them they could have been shown door to exist, by this manner without legally defaming this company you will be showing their real face to general public there by lowering its commercial reputation thus effecting their business. Usually all these insurance companies are using big film stars for their commercial advertisement, but the real power is in the hand of general public who buys their insurance by paying their hard earned money, once the general public fail to buy their insurance then let it be Amitabh Bhachhan or Sharukh Khan in their commercial advertisement, that wont make any difference in improving their business. Whether any M.B.A. agrees with me on this point or not.

Answer 2

Stay with it. Insurance companies thrive by denying claims.At the time of issue of policies they promise the moon,but come settlement time not even the reflection of the moon in a mirror is shown to the policy holder.He is given
short shrift and the hapless policy holder is
then required to incur the legal expenses to fight the behemoths which is a very one sided battle.Our courts would do well to award hefty
punitive damages to policy holders when they win their cases so that the insurance companies do not look at claims in a casual and.often supercilious manner.They need to be taught a lesson.Good Luck.

Answer 3

YOURS IS A MORALE BOOSTING VICTORY and many innocent and honest payers of premia will be delighted. And many more who were cruelly denied their due. There are many more who enjoyed their patronage even without fulfilling any of their criteria. That requires right connections and percentage. Yours is a condition in which atleast they had something to argue but by peculiar and incongruous arguments they deny even for the eligible. You also try to get the interest if you are entitled to in consultation with your lawyer , if not for the money but for pride and complete teaching a lesson to the company .You also involve the media and let people know the pros and cons and their rights to claims.Kudos and be a torch bearer for similar causes!

Answer 4

Myopia can not termed as ailment or any kind of disease and repudiation on the pre-existence is totally wrong. Myopia is short sightedness I suppose. It is actually happening or you can say ocular condition. Insurance Company's denial for claim even after such discloser by you, is great injustice to you. Consumer forum has given you part Justis. You consult best advocate and try for maximum compensation. Best of luck

Answer 5

Say what? If you are trying to figure out why an insurance company is denying your claim; forget it. That is their business, denying claims.