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Maternity claim from two corporate insurance policy

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12 Sep, 2022 by  vishnu ram

Me and my wife both have corporate insurance policy. Mine has a maternity limit of 1lakh and my wife has 75 Thousand. We paid Rs-1,29,000 as our hospital bill and raised a reimbursement from my policy and they informed the eligible amount is 1,27,000 and 1 lakh has been paid(my policy limit)


Now when we tried to reimburse the remaining amount of 27,000 from my wife Corporate policy, they rejected it by saying " The hospital final bill was Rs.129012 and submitted as a PART CLAIM for Rs.27432 claimed . On scrutiny of the papers we found that the customer has gone opted for higher room rent (as per policy terms only single a/c room charges is applicable) the claimant was eligible for the room rent of 

Rs.3600 per day but the claimant was admitted in the room rent of Rs.5200 per day and hence proportionate clause is applicable. As per our policy the eligible amount was RS.94748 was arrived. As the eligible limit was already settled thru other claims mentioned. We are unable to settle the claim."


Is there anything we can do?

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1 Answer

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13 Sep, 2022
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Hi Vishnu Ram,


As per the argument given by your spouse's company using the proportionate payment clause, you are not eligible for further reimbursement


In case you wish to understand the finer prints in the policy document, we can help you with it.


Use the schedule call now feature

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