Other side of consumer complaints

Rejection of claims by insurers constitutes the largest bulk of consumer complaints. Going by the sheer number of consumer forum verdicts that are reported almost every week against various insurers, it is easy to conclude that every single rejection of claim by any insurer in the country is a deliberate design to cheat the policy holder. Convenient as this conclusion is, the rejection is not mala fide in all cases. There is still a small but significant percentage of cases, where the insurer is not actually wrong and the rejection is valid.

There are several exclusions that are included in standard health insurance policies as ground for rejection of claims. This is a perfectly valid industry practice. However, more often than not, the consumers neglect to take these considerations into account when opting for a policy, and end up being caught completely unaware when their claim is rejected.

Non disclosure of pre-existing diseases happens to be the best illustration of this fact. Apart from mis-selling of insurance, this is the biggest reason for consumer complaints against insurance companies. Pre-existing diseases at the time of buying the policy and related complications are generally excluded. What concerns us much more is the number of rejections on this ground that are actually valid. This clearly indicates that policy holders frequently fail to register the importance of this disclosure. We have also found cases where consumers did not deliberately disclose pre-existing ailments.

Every prospective policy holder must make sure they disclose everything they know as far their health issues are concerned. It's better to disclose and know where you stand, rather than take the stress of medical treatment and the uncertainty of a payout.

There are multiple consumer complaints where claims are rejected for treatments which become impending right after the cover was opted for.

... contd.

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