Dear Mayank,
If you are injured in the office, is the management liable for compensation?
I walked into a glass door. Some of my other colleagues have done it too.
I have five stitches on my face and will have a scar.
I have asked for compensation for hurt caused and to cover my medical costs including cosmetic surgery to remove the scar.
The company says they are not liable in this case and whatever medical cost is there should be claimed via the company medical insurance.
Please guide me.
Trishal

Ans: Hi KD, hope your wife has recovered. To answer your query, I advise you to check your policy document again. There are many health insurance policies that have capping/limitations on the list of ailments. You can find the same in the policy documents or policy wording.

I suggest you approach your insurance company and inquire about the same and if you still fail to get a response from them then you can approach insurer ombudsman for this issue.

Ans: Hi Vijay, thanks for your wishes. All insurance policies cover pre- as well as post-hospitalisation charges. However, the coverage period for pre- and post-hospitalisation differ insurer to insurer.

Request to check your policy document to know the period covered by your insurer for post hospitalisation claim.

Ans: I’m sorry to hear about the accident and hope the boy is recovering well. It’s great that you took responsibility for his medical expenses. Since you have third-party insurance, you can potentially claim the treatment expenses from your insurance company. Here’s how you can proceed:

Steps to Claim Treatment Expenses from Third-Party Insurance
1. Gather Necessary Documents
Ensure you have all the necessary documents ready, including:

Insurance Policy Details: Your third-party insurance policy
Accident Details: Date, time, and location of the accident.
Medical Bills and Receipts: Copies of all the treatment expenses you paid for the injured boy.
Medical Reports: Any medical reports or discharge summaries from the hospital.
Witness Statements: If possible, get statements from any witnesses of the accident.
2. Inform Your Insurance Company
Contact your insurance company as soon as possible. Provide them with the details of the accident and the treatment expenses incurred. Inform them that you wish to claim these expenses under your third-party insurance.

3. Submit a Claim Form
The insurance company will provide you with a claim form. Fill out the form accurately, providing all necessary details. Attach the gathered documents, including medical bills and reports, with the claim form.

4. Cooperate with the Investigation
The insurance company may conduct an investigation to verify the details of the accident and the incurred expenses. Cooperate with their inquiries and provide any additional information or documents they may request.

5. Follow Up
Keep in regular contact with the insurance company to follow up on your claim status. This will ensure that your claim is processed promptly.

6. Payment to the Injured Person
If the insurance company agrees to cover the expenses, they may pay the amount directly to the injured person or reimburse you for the amount you have already paid. Confirm this with your insurance company and provide the injured person’s contact and bank details if needed.

Points to Remember
Document Everything: Keep copies of all communications with the insurance company, including emails, letters, and phone call records.
Legal Advice: If you face any difficulties in the claim process, consider seeking legal advice to ensure your claim is processed smoothly.
Possible Outcomes
Reimbursement to You: The insurance company reimburses you for the medical expenses you have already paid.
Direct Payment: The insurance company pays the medical expenses directly to the injured person or their family.
By following these steps, you can navigate the claim process with your third-party insurance company and ensure that the medical expenses are covered. Your proactive approach in taking responsibility for the injured boy’s treatment is commendable and should help in facilitating a smooth claim process.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: Health insurance covers medical expenses. It includes hospital stays, surgeries, and treatments. You need to check the policy details.

Coverage for Pre-existing Conditions
Pre-existing conditions are medical issues you had before getting insurance. These conditions often have a waiting period before coverage starts.

Your Specific Case
You mentioned a leg fracture. Since it's now two years old, check if the policy covers it. Most policies cover pre-existing conditions after a specific waiting period. Since your policy is now in its fourth year, it's likely the surgery will be covered.

Action Steps
Review Your Policy: Check the terms for pre-existing conditions and waiting periods.

Contact Your Insurer: Confirm coverage for your surgery.

Plan for Surgery: Ensure all paperwork and approvals are in order.

Future Considerations
Stay Informed: Keep updated on your policy's terms and conditions.

Regular Health Check-ups: This helps in early detection of health issues.

Emergency Fund: Always have some savings for medical emergencies.

Final Insights
Your health insurance is crucial. Ensure you understand its terms and use it wisely. Stay proactive about your health and insurance details.

Best Regards,

K. Ramalingam, MBA, CFP

Chief Financial Planner,

www.holisticinvestment.in