In the midst of the unprecedented COVID-19 pandemic, Mrs. Reena Girase found herself battling the highly contagious virus. As her condition worsened, she was admitted to a hospital for treatment. With hope for a speedy recovery, the family trusted the insurance coverage they had diligently maintained over the years.
However, the family’s hopes were shattered when they received a letter from her insurance company denying the claim for COVID-19 treatment expenses. The insurance company cited various reasons for the claim denial. The denial left Mrs. Reena and her family in a state of shock, struggling to comprehend the implications of the insurance company’s decision during this critical period. According to the insurance company, they found misinterpretation of material facts. Hence the claim was repudiated.
As the family began to lose hope because of the denial of their insurance claim, a glimmer of hope emerged in the form of Insurance Samadhan. Desperate for assistance and guidance, they contacted us. With our expertise and determination to help policyholders navigate complex insurance matters, Insurance Samadhan took up the case.
With little recourse left, we turned to the Ombudsman offices for help, hoping to find justice in their insurance claim denial. After a thorough review of the case, it was revealed that the insurance company had denied the claim on the grounds that the HRCT report submitted by the complainant was not signed by the doctor. Shocked by this revelation, the family questioned the validity of the insurance company’s reasoning. They were confident in providing all the necessary documents, including the HRCT report duly signed by the doctor.
An important point to highlight is that the insurance company failed to verify the papers or documents thoroughly. This lack of diligence resulted in potential oversights or inaccuracies. The family’s concern and fear of losing their money intensified due to the insurance company’s oversight in not carefully checking the papers or documents. Had the necessary precautions been taken, the family could have been reassured and spared from the stress they experienced.
The situation turned positive as the complainant’s case was resolved in their favor by the ombudsman’s offices. With the assistance of Insurance Samadhan, specializing in insurance-related grievances, the family successfully obtained their rightful claim money. This outcome relieved the family immensely, offering them the reassurance and financial support they needed during a challenging time. The diligent efforts of Insurance Samadhan played a crucial role in ensuring justice was served and restoring the family’s faith in the insurance process.
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