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| NCH Docket No.: | 2953855 | Dated: | 2021-09-09 | Sector: | General Insurance |
|---|---|---|---|---|---|
| Problem Reported: | In mid-September 2020, Consumer had taken a health Policy of 105 days tenure for a sum assured of ₹1 lac from a Private insurance company and had paid the Premium amount of ₹1724/-.Consumer was unwell, so he was admitted in a hospital in early October 2020, and as his COVID test came positive, he was shifted to another hospital the next day, in the COVID ward. After 3 days, his COVID test report came negative, so the next day he was discharged from the hospital. He had registered his claim with the Insurance Company by submitting all the required documents, but the insurance company rejected his claim stating the reason- ‘Hospitalized treatment not required’. So, he again forwarded the claim request with the company to cross check. He wants the claim amount to be paid to him | ||||
| Escalation by NCH: | As the insurance company is a convergence partner of the NCH, the grievance was responded by the company on the NCH Portal stating ‘The claim documents including the additional inputs provided to us were reviewed by our medical team and opined to consider the claim as per policy terms. Accordingly, we have processed and settled an amount of Rs.1, 00,000 through NEFT to your account on xxx as per policy terms and conditions.’ | ||||
| Consumer Remark in INGRAM: | Excellent! Thank u so much NCH. This company has refused to give my claim with unexpected reason but Thank u to NCH; finally I have received my claim. | ||||
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