Medical Insurance cancelled after 3 years
3 months ago
My mediclaim was cancelled on grounds of non disclosure of pre existing diseases.
I fell from the stairs and had a nerve pain which used to come and go. During the 4th year during home excercise suddenly my pain excruciated in the same area and I had opd diagnostic 1 day surgery. My claim was cancelled as in the prescription it was written leg pain since 7 years.
However 7 years back I had an MRI done and also an Xray which showed nothing. There was no proper diagnosis. Since there was no diagnosis It was impossible for me to disclose it an pre existing disease.
Is there any remedy in law or any case laws where some justice can be given to me
A.Dear Client,
In cases where an insurer cancels a mediclaim due to alleged non-disclosure of pre-existing diseases, you can explore legal options to challenge the decision. It is essential to gather all relevant medical records, including the MRI and X-ray results from seven years ago, to demonstrate that there was no conclusive diagnosis at that time. Engaging with a lawyer who specializes in insurance or health law can help you navigate the legal aspects. Presenting your case based on the lack of a clear diagnosis seven years ago and the subsequent nature of your condition might strengthen your position. However, the success of such cases often depends on the specific terms and conditions of the insurance policy and applicable laws, so seeking professional legal advice tailored to your situation is crucial.
Thankyou
In cases where an insurer cancels a mediclaim due to alleged non-disclosure of pre-existing diseases, you can explore legal options to challenge the decision. It is essential to gather all relevant medical records, including the MRI and X-ray results from seven years ago, to demonstrate that there was no conclusive diagnosis at that time. Engaging with a lawyer who specializes in insurance or health law can help you navigate the legal aspects. Presenting your case based on the lack of a clear diagnosis seven years ago and the subsequent nature of your condition might strengthen your position. However, the success of such cases often depends on the specific terms and conditions of the insurance policy and applicable laws, so seeking professional legal advice tailored to your situation is crucial.
Thankyou
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A.Dear Client,
Pre-existing diseases (PED) are mostly expensive to treat as they are chronic in nature. Unfortunately, most health insurance plans cover pre-existing diseases after a waiting period of 2 to 4 years as people are already suffering from such diseases at the time of policy purchase. PED comprises both life-threatening illnesses to minor ailments that most commonly include thyroid, high blood pressure, diabetes, asthma, cholesterol, cancer, diabetes, etc. The NCDRC, the apex consumer commission, has held that an insurance claim cannot be denied on the mere presumption that a person might be suffering from a pre-existing disease. NCDRC said even if the insured person was suffering from a disease and did not know about it nor was taking any treatment for the same, the claim cannot be denied by an insurance company. So, a standalone prescription stating that the patient has been suffering from a disease for the last 7 years without any supporting medical evidence cannot be a ground for repudiation of the claim on the grounds of non-disclosure of PED by the insured when a policy is running for a period for 4 years. So, in the prevailing situation, you need to file a complaint against the Insurance Company for deficiency in service and unfair trade practice before the Dist. Consumer Commission, claiming the entire expenses of the treatment along with compensation for harassment. The Complaint should be filed within two years from the date of cause of action, i.e, from the date of repudiation of claim by the Insurance Company.
Pre-existing diseases (PED) are mostly expensive to treat as they are chronic in nature. Unfortunately, most health insurance plans cover pre-existing diseases after a waiting period of 2 to 4 years as people are already suffering from such diseases at the time of policy purchase. PED comprises both life-threatening illnesses to minor ailments that most commonly include thyroid, high blood pressure, diabetes, asthma, cholesterol, cancer, diabetes, etc. The NCDRC, the apex consumer commission, has held that an insurance claim cannot be denied on the mere presumption that a person might be suffering from a pre-existing disease. NCDRC said even if the insured person was suffering from a disease and did not know about it nor was taking any treatment for the same, the claim cannot be denied by an insurance company. So, a standalone prescription stating that the patient has been suffering from a disease for the last 7 years without any supporting medical evidence cannot be a ground for repudiation of the claim on the grounds of non-disclosure of PED by the insured when a policy is running for a period for 4 years. So, in the prevailing situation, you need to file a complaint against the Insurance Company for deficiency in service and unfair trade practice before the Dist. Consumer Commission, claiming the entire expenses of the treatment along with compensation for harassment. The Complaint should be filed within two years from the date of cause of action, i.e, from the date of repudiation of claim by the Insurance Company.
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