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Thread: Mediclaim policy-definition of limit of sum insured

  1. #1
    Unregistered Guest

    Default 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.

  2. #2
    Unregistered Guest

    Default

    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.

  3. #3
    Unregistered Guest

    Default

    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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