Mumbai: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 'pre-existing 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.
According to the Insurance Regulatory and Development Authority (IRDA), applicants must submit medical records, details of ailments, diseases, diagnosis and hospitalisation for the last four years when buying medical insurance policies.
But consumer activists say that many private sector insurance firms provide medical insurance without even a simple checkup for people below the age of 45. "The insurance firms are out to capture the huge market and hence do not realise that they may get many false claims,'' Rajan Alimchandani,a consumer activist, said.
Consumer activist Jehangir Gai pointed out that the insurance companies' claim that the policy holder has been suffering from a disease for a long time is "proved wrong in the consumer court as they do not have solid evidence to deny the policy holder.''
The IRDA has now decided to introduce a uniform definition of 'pre-existing illnesses' binding on all companies.
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.
According to the Insurance Regulatory and Development Authority (IRDA), applicants must submit medical records, details of ailments, diseases, diagnosis and hospitalisation for the last four years when buying medical insurance policies.
But consumer activists say that many private sector insurance firms provide medical insurance without even a simple checkup for people below the age of 45. "The insurance firms are out to capture the huge market and hence do not realise that they may get many false claims,'' Rajan Alimchandani,a consumer activist, said.
Consumer activist Jehangir Gai pointed out that the insurance companies' claim that the policy holder has been suffering from a disease for a long time is "proved wrong in the consumer court as they do not have solid evidence to deny the policy holder.''
The IRDA has now decided to introduce a uniform definition of 'pre-existing illnesses' binding on all companies.
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