Disputes over medical insurance claims are on the rise in consumer courts across Mumbai and Thane, an increase attributed primarily to the fact that insurance companies are rejecting claims citing `preexisting illnesses'.Insurance companies agree that there needs to be more clarity on the term, but add that they have enough evidence to back their findings when they reject a claim.
``The problem is mainly at the applicant's end when he does not disclose fully what medical problems he has and then we get medical evidence to prove that he was in the wrong,'' said a senior official with New India Assurance Company Ltd.
According to the Insurance Regulatory Development Authority (IRDA), applicants have to submit their medical records, details of ailments, diseases, diagnosis and hospitalisation of the previous four years when taking medical insurance policies.
To deal with the situation, the IRDA has now decided to introduce a uniform definition of pre-existing illnesses that will be binding on all companies.
Source: Times Of India IRDA set to define pre-existing illness
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By nargis, Section Insurance & IRDA
Posted on Mon Jun 22, 2009 at 12:14:29 AM EST
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Consumer activist Jehangir Gai pointed out that the insurance companies' claim that the policy holders have been suffering from a disease for a long time is ``proved wrong when the case comes up for hearing at the consumer court as they do not have any solid evidence to back up their claims. They come with medical reasons not even remotely connected with the policy holder.''
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