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Claim repudiated u/s 4 (7) despite of disclosing PED in 2019

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12 Nov, 2022 by  Abhishek Puri

This is to share my experience where the co TATA AIG has repudiated the claim under non disclosure u/s 4(7) despite of paying premium for 3 yrs with 10Lac SA with PED of HYPOTHYROIDISM since birth, and disclosing all the medical facts transparently and upfront in the year Nov 2019 at the time of porting from STAR HEALTH INSURANCE, where the same policy was for 7.5 lacs and PED mentioned in old policy too.


I was admitted in Aug 2022 for UTI infection and discharge summary states CONGENITAL HYPOTHYROIDISM which means the same i.e Hypothyroidism since birth, then how come they can repudiate the claim on the basis of non disclosure.


Though I have written a very detailed email to their GRO and other people in the matrix highlighting the case and how blatantly the claim officer and their team have overlooked the my case where I have declared all the medical facts and their counter offer letter of covering the THYROID DISORDER, Can anyone from your esteemed organisation help further to ascertain the validity of my case, whether my contention and understanding is valid or not? 


My claim is just 86000 and waiting period with TATA AIG for the PED- THYROID DISORDER is for the incremental sum assured , that means no one can deny the claim upto Old sum assured of 7.5 lacs.


As this claim of mine is stuck so can I apply for my another claim which was in the month of Oct 2022, where I was operated for FISTULAOCTOMY. Because of my earlier claim being not settled and the question of repudiation is at stake I am unable to apply for reimbursement of my another claim for approximately 1 lac. There is a lot of confusion in case they completely deny my first claim and repudiate then my second claim will also stand cancelled as policy stands cancelled.

I would like to know the point of view of learned professionals like you dealing in this field and which government platforms we can share this to fast track the case and make the company realise the wrongdoings. And it will be great if I can get in contact with anyone of you with whom I can share the entire details so as to enable you to understand the case in much better way.
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17 Nov, 2022
MBA | 5 years experience
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Dear Abhishek,


I will prefer to speak with you on this as further details & documentation will be required. Could you please schedule a call


Regards

Rohit Dhingra

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29 Nov, 2022
We breathe insurance :)

Hello Abhishek,


Based on the facts mentioned above by you - if you have made clear disclosures when porting into the new insurer, your claim cannot be denied.


Would strongly recommend you further follow the grievance process. Now that you have written to the GRO, and if you haven't received a satisfactory response, you can write to IRDAI through their IGMS portal.


Here are the details to complain with IRDAI:

Call Toll-Free Number 155255 (or) 1800 4254 732 or

Send an e-mail to complaints@irdai.gov.in

Make use of IRDAI's online portal - Integrated Grievance Management System (IGMS): Register and monitor your complaint at igms.irda.gov.in


Regards,

Team Beshak

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