policy lapse for a month

POSTED BY sanchay ON October 23, 2012 12:40 am COMMENTS (9)

Dear sir,

I wanted to share and want advice from your side regarding claim from mediclaim policy. Recently my father suffered from a minor heart attack for which doctor recommended for coronary angioplasty stent operation which costed about 3.5 lacs. We have taken a mediclaim policy (floater ) for the family from National Insurance And TPA Alankit healthcare in which my father has mediclaim of 1.5 lacs . It is active since 2005. during the time of claim filing , we came across that there was a policy lapse in 2011-12 for a month due to cheque bounce . During that time , we just got a letter to pay the required amount again with additional Rs.100 for cheque bounce, we payed that and there was NOTHING mentioned that “FROM NOW ONWARDS IT WILL BE TREATED AS NEW POLICY”. Now the TPA has refused to give the claim as they wanted to submit policy continuation certificate(Endorsement Certificate) for that period of month and left us helpless.

I wanted to know is there any chance or hope to get some amount of mediclaim as it has been in continuation from past 6 years. And I also wanted to add that when the new policy documents were made and received they still have mentioned the previous policy number . If they took as new policy then why they have mentioned previous policy number.
Waiting for your positive reply .
Regards

Sanchay Ajmani

9 replies on this article “policy lapse for a month”

  1. sanchay says:

    Dear Sir ,
    There are some points mentioned in the letter from National Insurance :-
    1. “Please note that the above mentioned Policy/Collection stands cancelled since inception and we are not on risk in respect of above policy ”
    2. In case you want to take a fresh insurance please remit us immediately the premium in Cash/DD to enable us to assume the risk from the date of fresh collection subject to your confirmation that there has been no loss so far .
    Please provide some feedback regarding the above points .

    Regards

  2. sanchay says:

    Thank you Mohit Sir for your reply . i posted a grievance against TPA .
    I just checked the passbook and letter from National Insurance from i found cheque was dated .04/05/2011 (Wednesday) and on particular day amount was much more than premium amount . Even till 15/05/2011(Sunday) amount was more than premium amount . But on 16/05/2011 (Monday) was lower than premium amount . Some Collection No. is present with date 12/05/2011 .
    From all the above data some strong point can be made up to defend my point ?
    Hoping for some positive response .

    Regards

  3. Mohit Pandey says:

    Dear Sanchay,

    I am not able to understand why are you delaying put up a grievance to the TPA (it’s already 8 months delay).

    And regarding the agent, he is was not bothered to explain you about the T&C at the time of giving the policy that means he was just interested in his commission only then why you are bothered about him.

    Just go and put up a grievance to the TPA ASAP.

    Regards
    -Mohit

  4. sanchay says:

    Dear All,
    Please reply on the last asked question , so that i can proceed further .

    Regards

    Sanchay Ajmani

  5. sanchay says:

    Thanks alot for your concern . You have seriously boosted me up to file a case against them . Really thanks . I want to know one more thing , will be there some action taken against the agent also , as he is very close to family and we not want to include him in this legal matter .

    Regards

    Sanchay Ajmani

  6. sanchay says:

    Thank alot for your reply . Answers to the said questions :-
    1. This was the first time dad got a minor heart attack on 04/09/12 and the operation was on 07/09/12 , Though He is suffering from Diabetes from past 2 years .

    2. Our policy from 2007 To 2011 (i.e 2007-2008 , 2008-2009 , 2009-2010 , 2010-2011) dates are same like Policy Period – 15/05/2007 to 14/52008 midnight and so on, till 15/05/2010 to midnight 14/05/2011.
    For renewal we submitted cheque on 04/05/2011.
    On 27/05/2011 (assuming as the Dishonoured Premium Cheque letter is dated 24/05/2011.) received letter about bounce of cheque due to insufficient funds . Later we submitted the new cheque with “Fine of Rs, 100/- as penalty” (assuming that submitted new cheque in 2-3 days after receiving letter. )
    And we got new documents as policy period from 06/06/2011 to 05/06/2012 and still going same .
    And yes we were not informed as such by our adviser , he just told to give new cheque with penalty and no new documents were filled and signed by dad .

    3.Yes I ‘ am planning to file a case , but somehow me not able to get for what I should file the case as I wanted to clear some critical points which will help in making case stronger.
    I hope all the questioned has been answered . please contact if needed any other information.

    Regards .

    Sanchay Ajmani

  7. sanchay says:

    Dear Manish sir ,
    Thank alot for replying on my query for the first time 😛 . Hope you get time to reply in future also . Sir please tell me (us) also how to get decent knowledge about the field ! 🙂

    Regards

    Sanchay Ajmani

    1. paresh.kanani says:

      Same thing happened to me also, but it is just 3 days since cheque was bounce, but policy was expired before one week. Can you share your experience to tackle this situation?

  8. Let me get an expert on this ! 🙂

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