Legal Question in Insurance Law in India

I have a health insurance policy and l had undergone eye surgery last month, then l submitted the documents for claims. Firstly they rejected the claim with diagnosis Cataract. Again l put a request to reopen the case - now company rejected. Please find the rejection reason as below :-

As per the certificate of the treating doctor submitted by the insured, the present illness is Phakia Rhegmatogenous Retinal detachment and it is a complication of Myopia suffered by the insured(for long duration). Hence it is a pre-existing disease.

My policy is not completed one year. Request your expert advice to further action.


Asked on 6/08/12, 11:53 pm

1 Answer from Attorneys
BHARAT NARASGOUDA BHARAT NARASGOUDA

If it is a pre exiting disease and you knew about it and if you have not mentioned it in your form at the time of entering into the Policy agreement than they will certainly reject as you have hided the said thing, further if it is not a pre-existing disease and you never new than file a complaint in the consumer forum and get your claim.

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Answered on 6/09/12, 6:31 am


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