• Dispute against Insurance company for rejecting claim in Hyderabad consumer court

We filed case in Hyderabad LB Nagar consumer court against a insurance company for rejecting claim of my mother's paralysis treatment and rehabilitation. Reason for rejection given by the insurance company was that rehabilitation expenses won't be covered under the policy.
https://drive.google.com/file/d/1BV7-6ZpQaPimq3RwaW8RzxEcwlClEBqG/view?usp=drivesdk

Above is the policy clauses, terms and conditions.
Hearing is on 06-Mar-2024.
I am requesting your advice in hiring a very competent and affordable lawyer.
Asked 10 months ago in Consumer Law

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5 Answers

Convalescence, general debility, Run-down condition or rest cure, nutritional deficiency states, psychiatric , Psychosomatic disorders, Congenital
external disease or defects or anomalies ( except to the extent provided under Section 2 for New Born ) sterility, venereal disease, intentional self
injury and use of intoxicating drugs/alcohol.are excluded 

 

2) hence your claim has been rejected ( under exclusions clause 9) 

 

3) search for lawyers on this website from Hyderabad 

Ajay Sethi
Advocate, Mumbai
97244 Answers
7854 Consultations

I am firm Mumbai. I appear all over India. If you can afford my fees can appear for you in Hyderabad .

Sir,
If you need any further assistance for the same.You can approach me through Kaanoon or LinkedIn.

https://www.linkedin.com/mwlite/in/prashanth-nayak-5477b138

You can ping me on 09 yu 769 fg 490 ghj 911

 

Prashant Nayak
Advocate, Mumbai
32675 Answers
207 Consultations

You can look for an advocate suiting your taste and requirement by visiting the local advocate bar association.

you can contact the advocate from this website if you come across any advocate hailing from the place you mentioned

T Kalaiselvan
Advocate, Vellore
87446 Answers
2348 Consultations

Dear Client, 

Direct grievance registration is available through the "Bima Bharosa System," an online platform operated by the Insurance Regulatory and Development Authority of India (IRDAI). The main statutory authority that oversees and controls the insurance industry in India is the Insurance Regulatory and Development Authority (IRDA), which was established by the IRDA Act. By ensuring prompt resolution of insurance claims and the avoidance of fraud and malpractice by insurance companies, the Insurance Rights Development Association (IRDA) seeks to advance and safeguard the interests of policyholders in India. The Insurance Regulation and Development Authority (IRDA) established the Integrated Grievance Management System (IGMS) to facilitate online complaints against insurance companies. A distinct complaint ID is provided to the concerned department for dispute resolution when an insurance advocate in India files a complaint online on behalf of the policyholder. You may also lodge a complaint against an insurance provider with the Insurance Ombudsman, who is another entity to deal with. To complain to the insurance ombudsman, an individual or his legal heirs may do so. The insurance ombudsman may investigate the following types of insurance issues: rejection of an insurance claim, either in full or in part , disagreement on how much of the premium is paid or owed. Legal analysis and interpretation of an insurance policy in relation to a claim. postponement of insurance claim settlement. non-issuing of insurance following payment of the premium. You have one year from the date of an insurance claim's denial, refusal, or delay to register a complaint with the insurance ombudsman. You can file a complaint with the relevant consumer forum if the issue remains unresolved after you have tried the IRDA or the insurance ombudsman. In India, consumer forums are divided into three levels: District discussion forum if the insurance claim's total worth is less than Rs. 20 lakhs, a complaint may be made. State Commission if the total amount is more than Rs. 20 lakhs but less than Rs. 1 crore, a complaint may be filed. National Commission when the entire amount exceeds Rs. 1 crore, a complaint may be submitted. 

Hope this answer proves beneficial to you.

Anik Miu
Advocate, Bangalore
10289 Answers
121 Consultations

- As per the Supreme Court , the Insurance Company cannot take a defence that did not form the basis of repudiation of the claim . 

- Since, the Company has accepted the Mediclaim policy , then the company cannot reject the claim. 

- You can engage a lawyer from this website. 

Mohammed Shahzad
Advocate, Delhi
14647 Answers
224 Consultations

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