Regarding Repudiated Health Insurance Claim

Community Forums Legal Advice India Regarding Repudiated Health Insurance Claim

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    • #72846 Reply
      User_cfff59bd
      Participant
        U
        User_cfff59bd
        PARTICIPANT
        January 17, 2025 at 3:39 am
        Hey, I’ve posted in the personal finance India community regarding a disappointing experience with Care Health Insurance. Here’s the post if you’re interested: https://www.reddit.com/r/personalfinanceindia/s/8fdfwKBGUu

        My query to legal advisors is that, what can I expect from this grade A level fraud case? Can I expect a huge monetary compensation with a max ceiling of 25L? I think that at some point they may approach me to settle the claim for once but that goddamn ship has already sailed and I’ve decided to fight. Please advise me on the possible repercussions. Thank you!!

      • #72847 Reply
        Ashishmaster940
        Participant
          A
          Ashishmaster940
          PARTICIPANT
          January 29, 2025 at 6:07 pm
          Lawyer here.

          Your compensation will depend upon your claim amount.ย 

          Status of irdai complaint?ย 

          • #72848 Reply
            User_cfff59bd
            Participant
              U
              User_cfff59bd
              OP
              January 30, 2025 at 9:08 am
              Okay. I believe that, if we win the case, then we will get the claim amount plus some compensation amount, please correct me if I’m wrong. Claim amount is around 34k.

              I got a generic reply from IRDAI stating that the case has been escalated to Care Insurance but haven’t received any reply and it’s been around 9 days. So I’ll have to raise this as a case in their mentioned portal, forgot the name.

              Should I take this to consumer court? Me and my dad were waiting for the reply from IRDAI then thought of waiting for another two weeks, hoping for Care’s reply. What’s your take on this?

              I know that the claim amount is very less for a big company like this, but still wanted to see IRDAI penalizing them, even if I don’t get any compensation.

              • #72849 Reply
                Ashishmaster940
                Participant
                  A
                  Ashishmaster940
                  PARTICIPANT
                  January 30, 2025 at 9:53 am
                  Wait for reply from IRDAI. Thereafter, think about consumer complaint.

                  • #72850 Reply
                    User_cfff59bd
                    Participant
                      U
                      User_cfff59bd
                      OP
                      January 30, 2025 at 9:59 am
                      Okay thanks. I don’t think Care is gonna reply to the incident, as it’s already been nice days and any business org will try to provide resolution within 3-5 working days and that’s not the case here. So, my plan is to raise a complaint in IRDAI mentioned portal, as told by them in the mail, then wait for their reply. Consumer court will be kept as the last option.

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