I have 2 health insurance policies of 5 lakhs each. If my claim, let us say, is 4 lakhs and one company settles at 2 lakhs, can I claim with the second company for balance amount? One insurance company rejected my policy for some reason. Later, another company approached me, and I took a policy. I had only signed the document and I do not know the details. To this company, I have paid premiums for 10 years without break. Can this company reject my claim in the future?

Ans: You can have 2 health insurance policies but cannot claim reimbursement for the same expense from multiple insurance companies. Also, if the sum insured of one policy is not adequate then the other insurance policy can be used to cover the balance expenses with proper disclosures to the second insurance company.

The rejection of any claim is basis incomplete or incorrect disclosure at the time of policy issuance or on account of applicable terms and conditions. I would advise you to go through the terms & conditions of the policy/ies purchased by you.

DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Users are advised to pursue the information provided by the rediffGURU only as a source of information to be as a point of reference and to rely on their own judgement when making a decision.

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Sanjib Jha | Answer |Ask -Follow

Insurance Expert - Answered on Jun 21, 2022

Question by S - Jun 21, 2022Hindi

Dear Sir, Greetings of the day. I have got a health insurance of family floater type from Tata AIG for a sum of four lakhs. Recently, I got hospitalised and full four lakhs was paid by Tata Aig. But my hospital bill was six lakhs and sixty two thousand. So there was a shortfall of two lakhs sixty-two thousands. I have an Aditya Birla health Policy of family floater type for 45 lakhs. But it will come in to effect after 5 lakhs expenditure. So I myself paid one lakh from my pocket. And for rest one lakh sixty two thousand only I applied for cashless to Aditya Birla .But they denied it. Finally I paid that amount myself and came home. Afterwards I kept continuous follow up with them. Reconsideration and reminder letter was sent by TPA and Treating doctor. But again it was rejected. Now Aditya Birla employee is saying apply for reimbursement. When Tata Aig is clearing full amount, how come Aditya Birla is denying it? And how can I bridge the gap one lakh between two policies? Tata Aig says you have taken full claim so we cannot make your limit from four to five lakhs this year. Pls advise suitably. Best Wishes

Ans: Hi Mr. Tripathi, greetings to you. To answer your first question as to why Aditya Birla won’t provide you with cashless claim as opposed to TATA AIG is because the policy you bought from Aditya Birla is a ‘Super top up plan’ which basically means it is an addition to your base policy which in your case is your TATA AIG policy.

Super top up policies do not offer cashless claims but only provide reimbursements.

The one lakh gap, unfortunately, cannot be filled at this point. However, while renewing your policy you can opt for increased sum insured with TATA AIG. The insurer will ask you a set of questions and schedule medicals to analyse your risk profile. Post that based on your reports, the insurer will take a decision on increasing the limit.

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