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Ramalingam Kalirajan3728 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 08, 2024

Asked on - Mar 26, 2024Hindi

Hi sir, my mother taken health insurance from religare in 2019 for 3 year..she switched to Bajaj in 2022 for next 3 year..when she claimed for cataract surgery Bajaj rejected due to 2 year waiting period. Previous policy waiting period not carry forward. What should she do?
Ans: I understand your concern about your mother's health insurance claim being rejected due to the waiting period clause. Here's what she can consider doing:
1. Review Policy Documents: First, carefully review the policy documents of both the Religare and Bajaj health insurance plans to understand the terms and conditions regarding waiting periods, coverage, and claim procedures.
2. Contact Bajaj Customer Support: Reach out to Bajaj's customer support or claims department to discuss the situation and seek clarification on the rejection of the claim. Provide all relevant details and documentation related to the policy switch and the cataract surgery.
3. Appeal the Decision: If Bajaj maintains its decision to reject the claim, consider filing an appeal with the insurance company. Provide additional information or documentation if available to support the claim and demonstrate the necessity of the surgery.
4. Seek Assistance from Insurance Ombudsman: If the appeal with Bajaj does not yield a satisfactory outcome, your mother can approach the Insurance Ombudsman for assistance. The Insurance Ombudsman is a regulatory authority that resolves grievances and disputes between policyholders and insurance companies.
5. Consult Legal Counsel: In cases where the insurance company's decision appears to be unjust or in violation of the policy terms, seeking legal advice from a qualified lawyer specializing in insurance law may be necessary. They can provide guidance on the available legal options and represent your mother's interests if required.
6. Consider Policy Renewal Options: Depending on the circumstances, your mother may also explore options for switching to a different health insurance provider or policy during the next renewal period. Ensure thorough research and comparison of policy features, coverage, waiting periods, and claim settlement records before making a decision.
It's essential to act promptly and diligently in addressing the issue to ensure that your mother receives the rightful coverage and benefits under the health insurance policy.

Best Regards,
K. Ramalingam, MBA, CFP,
Chief Financial Planner
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