I have been pursuing my claim with a Health Insurance company , but the company has failed to provide me with satisfactory responses to my queries. Moreover, I was misguided at the time of inquiry, and subsequently, my claim was rejected at the time of discharge after giving initial approval in planned treatment. I am not getting a satisfactory response After many emails, calls to grievance, co md ,compliance , irdai till now. the issue is going on.. Please help and advise me what I have legal options and how I can challenge them in court of law ? What is the best way to fight legally?
Whenever a health insurance company rejects or settles or partially settles a claim it has to communicate the reasons to the insured. Its formal letter contains a table with details such as particulars of claim, amount paid by the policy holder, amount settled / partially settled / rejected by the health insurance company and in the last column reasons for the same. If you have received this letter you may check the reasons, cross verify with the policy terms and conditions and if not satisfied, take up the matter first with the nodal officer. If he is not responding then the matter should be taken up with the Insurance Ombudsman (and not with IRDAI) of the state where you are residing. You may write to us again if there is any specific anomaly. You may also visit Moneylife Foundation's office with prior appointment and with all the papers if you are from Mumbai.
Our Experts

Shirish Shanbhag Shirish Shanbhag has an MSc in Organic Chemistry, Diploma in Higher Education, a Diploma in a French and has completed his LL.B. in first class, in 2021. Before his retirement, he was a junior college teacher at Patkar College from July 1980 to May 2012, where he taught theoretical and practical chemistry. Post retirement in 2012, he started providing guidance and counseling to people on several issues, with a specific focus on co-operative housing society related matters. Adv Shanbhag has a kee

AV Shenoy AV Shenoy hold degrees in both Mechanical and Electrical Engineering from VJTI, University of Bombay and a Post Graduate Diploma in Industrial Management from Jamnalal Bajaj Institute of Management Studies. Worked as a Design Engineer in Electrical Business Group of Larsen & Toubro Ltd. at Powai from October 1969 to September 2001 and retired as Dy. General Manager. Also worked as a Facilitator/Trainer for implementation of Total Quality Management (TQM) and ISO 9000 in the organization. Since r

Abhay Datar Abhay Datar is a consumer activist. After working at Bank of Baroda for about 29 years, he retired as IT Manager. After retirement, Mr Datar joined Consumer Guidance Cell of Mumbai Grahak Panchayat (MGP) in 2008 and solved many cases related to banking including online fraudulent transactions, misuse of credit cards and ATM cards. Also handled cases related with mobile banking frauds and mediclaim. He was a Member of the Managing Committee of MGP till March 2021.

Shailesh Gandhi Shailesh Gandhi is a former Central Information Commissioner for the Right to Information Act. He is a successful RTI activist and a regular speaker at Moneylife Foundation.

Dr Rajendra Ganatra Dr Rajendra M Ganatra, was a banker for two decades and is now a registered Insolvency Resolution Professional, restructuring consultant and visiting faculty for MBA. He has more three decades of experience in project finance, asset reconstruction and financial restructuring. He is a Registered Insolvency Professional and has been the former MD & CEO of India SME Asset Reconstruction Co. Limited

Samir Zaveri An extraordinary activist who has dedicated his life to the cause of railways, with a mission to help every rail commuter and accident victims, and improve Railway safety.

Yogesh Sapkale Yogesh Sapkale is Deputy Editor of Moneylife and writes on legal, RTI, and consumer issues

Sucheta Dalal Trustee - Moneylife Foundation

NOTE
Please do not share in your query any personal details like name, mobile number, email ID, address, bank account or other account details.

To ask a question

Please
Sign Up or Sign In
with
than you