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A practical question on dual policies (co-insurance)

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10 Sep, 2021 by  Sharad

I have 2 mediclaim policies, one from employer and another personal (say Policy A and Policy B). I claimed certain post hospitalization expenses (physiotherapy charges for physiotherapy done at home). Per policy A, only 50% amount was passed because physiotherapy was done at home and not at clinic. I got that amount. Now for 50% deduction when I go to Policy B they deny paying and said we also have 50% clause on home physiotherapy and you have already got 50% from policy A, so we will not pay this.


My question is that is it a fair practice or there is a merit in raising this to ombudsman or irda?


Please guide.

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1 Answer

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11 Sep, 2021

Hi Sharad,


Technically their decision is fine. Had you approached both Insurers together, they would have paid 25% each under co-insurance.


Let my more competent colleagues on this forum also share their views. You can specifically write to 2 claims experts -


Anuj Jindal (co-founder, Sure Claim) - his mail ID is anuj@sureclaim.in


Shailesh Kumar (co-founder, Insurance Samadhan) - he can be reached at corporate@insurancesamadhan.com


Regards

Asad

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