Mediclaim can’t be rejected if original bills are lost: Here’s why

In a relevant order, a consumer forum has held that if an individual has lost their original bills but can provide the duplicate bills, their Mediclaim then cannot be rejected by the insurance company.

According to a report in Times of India, A Mumbai doctor, Satyapriya Dhabuwala suffered from a brain hemorrhage in 2012, the district forum had ordered New India Assurance Co Lt and Health India TPA Services (I) Ltd, to pay Rs 2.21 lakh compensation (reimbursement of Rs 1.71 lakh and rest as interest and costs.)

The forum observed that Dhabuwala had been purchasing the insurance policy since 2004 and also renewing it by paying the annual premium. Over the order of the consumer forum, Rupam Asthana, CEO, Liberty General Insurance Firm had said, “In absence of an original bill the consumer should not suffer in the era of technology, the insurance firm should investigate the case with the hospital bills itself.”

INSURANCE: Critical illness cover can add to Mediclaim
Critical illness health insurance pays a fixed amount if you get any of the diseases listed in the insurance. This benefit amount is not linked to the costs one incurs. The diseases are defined in the policy wordings and buyers should take comfort from the fact that these definitions are supervised and standardized by the insurance regulator. The insurance is terminated once a claim is paid and cannot be renewed. These insurances may be bought as standalone individual plans or as riders to life insurance.

Critical illness differs from standard Mediclaim in three ways. The critical illness benefit is fixed per illness, whereas Mediclaim covers actual hospitalization expenses. Critical illness pays if you suffer a specified disease, whereas Mediclaim covers hospitalization costs for any illness. Critical illness terminates when you claim whereas Mediclaim can be renewed life-long even if you make a claim. For these reasons, we suggest buying critical illness as second, supplementary insurance, only after we have your basic health insurance in place.