This is a discussion on Mediclaim policy-definition of limit of sum insured within the Medical Insurance forums, part of the Insurance category; I fell sick in year 2003, and filed a case in consumer court for my treatment against Mediclaim policy, as ...
Mediclaim policy-definition of limit of sum insured I fell sick in year 2003, and filed a case in consumer court for my
treatment against Mediclaim policy, as Insurance Company refused to
pay.
Sum insured according to policy is defined as under:
Basic Value of sum insured: 1,50,000.00 plus 15% cumulative bonus (Rs
22,500.00).
"According to policy it is stated that sum insured shall increase
gradually @ 5% in respect of each claim free year of insurance, which
thus becomes Rs 1,72,500.00".
This year court gave judgment that I be paid an amount of Rs 1,50,000
with 9% interest per year and allowed me if I want to file a case
separately
according to Insurance limit of Rs 1,72,500.00. It was due to the
appeal by Insurance Company that theory of increase in insurance
limit due to addition of cumulative bonus amount is not applicable
and I
be paid for 1,50,000.00 as explained above.
I had incurred an undisputed expense of Rs 1,87,096.40.
My concern is simple as I want to know exactly that:
1) What Insurance companies mean by increase of limit of sum
insured due to the addition of cumulative claim bonus for each claim
free year.
2) Is it a vague and misguiding term?
3) If not then how I can prove to the court with evidences that
insurance limit in this case is 1,72,500.00 and NOT 1,50,000.00.
I would appreciate ANYBODY'S response for me and for the knowledge of
all.
172500/- is the correct limit.Please elaborate on your commencement
year of mediclaim policy and no.of claims made till 2003.
was there any communication IN WRITING between you(Insured) and
insurance co for last FIVE years ???
Which is the Insurance co.?-Is it a PVT.gen.insurance co OR a PSU ??
This case should have been cleared by Insurance Ombudsman nearest to
your city.
I am very much thankful for your response. My concern here has been awareness
to the people and accordingly justice. It is very normal that Insurance
companies have nagging attitude when it comes to the payment.
Anyway my insurance company is " Oriental Insurance Company" and having this
mediclaim policy from their Gorgon Branch as I am resident of Gurgaon.
I attach consumer court judgement issued on 9Th March 08 which is self
explanatory for subject matter. They have not paid until now even based on
1,50,000.
Further I want to understand and pursue for the difference as covered in
subject matter.
There is clear cut narration in judgement that how the payment dropped down to
1,50,000.00 from 1,72,500.00.
I am in abroad at the moment otherwise I could have attached copy payment to
of instalment in 2003 where it states clearly for accumulated to 15%(22,500,00)
@ 5% per Annam.
I thank you once again and look forward for assistance if possible from you
side.
Best regards
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