Sharma stated that she fell sick on December 30, 2019, and was admitted to the Max Tremendous Specialty Hospital for a interval of eight days and the hospital despatched pre-authorisation request to the insurance coverage agency however the identical was rejected, vide letter December 31, 2019, on the grounds that the complainant had disclosed cough signs.

Sharma alleged that she was discharged from the hospital on January 6, 2020, and he or she needed to pay a invoice raised by the hospital to the tune of Rs 3 lakh. The daughter of the complainant once more requested the insurance coverage agency to rethink the mediclaim however they once more repudiated the identical.

On service of discover, TATA AIG Insurance coverage Firm Restricted in reply said that after scrutinising the paperwork/indoor case papers, the pre-authorisation request was rejected on the grounds that the illness/signs of cough for 3 months is previous to coverage inception, which is November 11, 2019, as a result of as per phrases and circumstances of the coverage any pre-existing situation won’t be coated till 48 months of steady protection with insurance coverage agency.

The fee noticed that the declare of the complainant was rejected by the insurance coverage firm on the grounds that the illness/signs of cough, fever and diabetes are previous to the inception of the coverage and any pre-existing circumstances won’t be coated till 48 months of steady protection as per Part 3-Basic Exclusions of the phrases and circumstances of the insurance coverage coverage. Nevertheless, the submission of the Firm deserves to be rejected as a result of signs of cough, fever and diabetes can’t be termed to be pre-existing ailments for rejection of the declare and fairly the identical are results of regular put on and tear of modernday life, which is filled with stress on the place of job, out and in of the home and are controllable on a day-to-day foundation by commonplace remedy.

Apart from this, previous to acquiring the insurance coverage coverage, the complainant had disclosed to the insurance coverage firm that she is a asthmatic affected person and he or she had additionally paid further premium of Rs 1,129 on this depend to the insurance coverage firm, held the Fee.

Discovering the rejection of the real declare of the complainant by insurance coverage firm to be unlawful and unjustified, the fee requested the TATA AIG Insurance coverage Firm to pay Rs 3 lakh to the complainant.