Cancellation of health insurance policy
Below are the details:
My brother, Saurabh Tekriwal had taken a Healthcare Policy for our mother Mrs. Usha Devi Tekriwal from Niva Bupa in mid-August, 2022. We gave all the correct information to the employee of the insurance company over the phone from which we had taken the policy directly (no involvement of any agent).
But unfortunately, in the last week of October, 2022, Breast Cancer was detected. My mother is now being treated in Tata Medical Center, Kolkata and in Doctor's prescription, it is mistakenly mentioned that she is being treated for depression for past 1 year.
Since, this disease was covered in policy terms (after 30 days), we went for cashless claim, the insurance company declined for the same and told us to go for reimbursement.
Now for the reimbursement, we duly uploaded all the required papers. We also sent all the original papers to the insurance company sought by them in mid-December, 2022. A member from their investigation team also visited us and the hospital and took the relevant information and papers and submitted further.
But on 03.01.2023, the insurance company sent us a Notice (via email) for the Cancellation of the Policy on the ground of mis-representation (or non-disclosure) of material fact of ongoing treatment for depression of my mother.
For the matter of fact, at the time of taking the policy, my mother was off the medication for depression for the last 6 months and the same is certified by her treating doctor Sandip Ganguly. We have the copy of doctor’s certificate.
We first ask the insurance company to consider the same. They denied. Then, we moved to the company’s grievance cell. They also denied. Then we had to move to the Insurance Ombudsman and unfortunately, the Ombudsman also awarded the decision in favour of the Insurance company.
Please let us know what steps we can take on this matter to make a rightful claim.
Thanks & Regards