Oct 20, 2006 07:53 PM
20499 Views
-The Insurance Co. is supposed to take care of its Customers’ needs as per the policy terms, conditions & assurances and as per the principles of Insurance.
-The IRDA is the Authority appointed by the Central Govt. and is also responsible to protect the interests of the Policyholders.
-Every Insurance Co. shall have in place proper procedures & effective mechanism to address complaints & grievances of policyholders efficiently and with speed. The name & address of the Insurance Ombudsman shall be communicated to the policy holder alongwith the Policy document.
-I have certainly seen some Public Sector Insurance companies and their T.P.As. flouting the principles & rules of Insurance as far as Mediclaim Insurance is concerned.
-Mediclaim Insurance is in the HEALTH sector and the most heavily demanded policy today. -When a loved one is ill, the last thing you would want to bother about is where the treatment & hospitalization cost is going to come from.. A mediclaim insurance policy allows you to protect your self & loved ones against today’s spiraling medical costs, while at the same time ensuring that in case of any unfortunate incident, you and your family can get hassell-free medical care. Taking the policy today would be a small price t pay for the peace of mind later. We Indian citizens mostly go to Public Sector Insurance Cos. thinking & believing that the Govt. will not let us (citizens) down. But THIS thought & belief barely holds good any more as you will see from the experiences below.
-In Mediclaim Insurance the Policy Holder may take an Individual or a Family/Group policy to protect oneself & family.
The Act states that every policy covers a period of 12 months(ONE year) and in the beginning there are certain EXCLUSIONS such as ..
All Pre-Existing Illnesses - which can never be covered at all by the Insurance Co.
A number of specified illnesses contracted within the first 30 days of the policy.
3. A specified number of illnesses contracted within the first year or/and the first two years of the policy.
Other specified expenses. Etc.
Ø Today some Private Insurances Companies cover these pre-existing illnesses after the3rd or 4th continuous policy claim free year.
To Include & cover these specified illnesses it is IMPERATIVE to renew the policy before it expires every year until the maximum year of cover. This continuity MUST be maintained year after year without a break to be entitled for continuous cover. Each Insurance company fixes its own maximum year for cover which vary from 60 years to 75 years while the maximum year for entry vary from 54 years to 70 years.
Well, I know an Insured Citizen who had maintained this continuity for the past 15 years with the New India Assurance Co. Chennai, payment made through his CityBank Credit Card till 2005 when he discontinued his Card in March 05.
His policy was to expire on 31-1-2006 and he wrote to NIA much in advance to transfer the policy to Mumbai where he could pay directly. His email and reminders got him no response.
In December 05 END he received renewal notices from both, Citybank Cards as well as NIA. Chennai, & wrote to both to renew the same against Immediate payment in advance – Pat came the reply:
Ø From Citibank : Your Credit Card is closed and Hence NO renewal possible.
Ø From NIA:Your policy will be automatically renewed.A Very Funny reply isn’t it ?
Due to his vast experience, he sensed an Urgent Need to act immediately.
He visited the NIA 140104 branch office at Santacruz with his proposal form for renewal.
The Manager refused to accept the same…
1) demanding that he apply afresh for an Individual Family Mediclaim policy
2) His Mother who was 81 would not be given an entry.
3) His TWO elder children though below 24 yrs would not be given a policy as they had
just begun working.
4) His Wife and Himself (both above 45 years) would have to first undergo a strict medical
test costing Rs.3000/-(at his own expense) to check for Pre-Existing diseases (which
would be totally excluded if any, from all future policies)
5) the premium would be Loaded by 20 % for LATE ENTRY (being above 45 years)
6) Compulsory Minimum Individual policy is now raised to Rs.1,00,000/- so he would have
to pay a much bigger premium for his wife, his younger child and himself.
He was SHOCKED, he had only 2 weeks left for his policy to expire.
Under protest he went through the whole process and his stress test (TMT) at peak level showed a mild problem. His tests also showed a mild swelling in his prostrate gland. (which the examining Dr. said is always natural in men above 45 years of age)
Yet Both these MILD observations were written down as Pre-Existing & excluded by NIA even though they never did trouble him in the least and he was never aware of them..
Following the Insurance Act, and as he was covered by the same very Insurance Company continuously since the past 15 years, these mild observations cannot be treated as Pre-Existing, there was no need for Medical Check up and no need to Load the premium by 20%.
BUT WHO KNOWS ALL THESE RULES ? The poor man went ahead and purchased the New Policy from Mumbai and is now excluded for life from the above mild observations listed as pre-existing. He went through all this just to prevent the break in continuity as per the Insurance policy and the Insurance rules.
So he immediately appealed to the NIA, its Grievance Manager, Its Chairman, The Insurance Ombudsman and finally the IRDA requesting these authorities to delete the exclusions and give him a clean cover sheet as per rules of the Insurance Act..
Its NINE months completed and even after reminding them there is no positive reply/response from any one. The IRDA Officer on Special Duty always replies stating that they have taken the matter up with theCo. and will get back to him at the earliest.
So he has to wait and wait keeping in mind that Justice Delayed is Justice Denied. In the next couple of months the policy will expire and the poor soul would have lost everything.Renewing it
