My father (age 68) has been diagnosed with Multiple Myeloma ( cancer on 21st May 2019. All his tests , diagnosis reports and doctors letter state the same. I had him insured in Dec 2018 with HDFC ergo. They had some tests done on Papa, after which they issued the insurance cover. They have however been refusing insurance saying that the condition was pre-existing which is not true. They are basing this on the doctors history letter which states that he had Malaria in October and Herpes in feb. We have issued multiple letters by the oncologist at Jaslok saying tests and diagnosis both have happened in May only. Inspite of the above they are rejecting the claim. I am at a dead end now and in a bad situation since papa is retired. Most importantly why did they issue insurance if they claim the condition was pre Existing since they had done tests . More over what basis do they have to prove the same? Kindly help with the due action that I can take
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You need to reply to their (Insurance Company's) deny reason along with proper notification and then file case with tribunal and IRDA, consumer forum.
Here proper brief should prepare and then reply to insurance company including all pre and post diagnosis of policy.
And need to verify the policy terms and conditions including plan.
File a consumer complaint against the insurance company for rejecting the claim as they have checked and diagnosed and now wrongly denying the claim.
File complaint against insurance company before consumer forum and seek orders to direct insurance company to pay insurance claim
2) also seek litigation costs and compensation for mental undergone by you
you can approach Consumer forum of your district to file an insurance claim against the HDFC company,
engage one prudent lawyer, discuss the matter thoroughly along with all relevant documents and act accordingly
File a consumer complaint for deficiency of service and take urgent as interim orders for the same
You can file a consumer complaint against the insurance company before the consumer forum. But to provide appropriate opinion, all the policy documents and the correspondences exchanged with the insurance company, if any, need to be looked into in totality.
This is a flimsy reason for the insurance company to reject the claim.
You may first issue a legal notice and then drag them to the consumer forum seeking relief and compensation.
This is a fit case and you will succeed.
Dear Client
If they have done medical test before issuing the policy and the reports at that time was normal and shows no sign of cancer then Insurance company cannot reject your claim by stating the reason that disease is pre-existed before policy issue of policy.
Now you can file a complaint against the Insurance company for rejecting the claim without any legal ground of rejection in Consumer Forum to make them pay the insurance claim as well as compensation for harassment you have suffered due to unfair practices of Insurance company.
If father had no previous history of any such decease and only after insurance cover acknowledge the deceased, claim cannot be rejected.
insurance claim cannot be denied on mere presumption that a person might be suffering from a pre-existing disease and 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.
File consumer complain.
