Why did it take a Gujarat resident 8 years to receive his son’s death claim?

A resident of Anand, Gujarat tragically lost his 22 year old son in 2013 to poor health. He went on to file a ₹5 Lakh death claim with his son’s life insurance policy, where he was the nominee.
(1/9)
However, his claim was denied by the insurance company on the grounds that the deceased was suffering from mental health issues for which he was hospitalized- a detail that had not been disclosed to the insurance company.
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The problem was, insurance companies usually keep coverage for mental illness outside the purview of Health and Life Insurance policies. This has long been a point of contention, even though the 2017 Mental Healthcare Act expanded insurance coverage to mental illness.
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According to the act, insurers are to treat policyholders making a claim for mental illness the same as they would someone seeking treatment for a physical ailment.

But as has been observed so far, these regulations have not been properly implemented.
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Insurers are still wary of including mental health coverage because now the addressable claims have risen within the same premium, making it harder for them to profit.
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Let’s come back to the case. After a failed complaint to the Anand district forum, the State Consumer Dispute Redressal Commission made a ruling in the beneficiary’s favor 8 years later.
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They observed that there was no concrete proof of the deceased’s mental illness as the insurance company’s arguments were based on oral statements by the locals.
The burden of proof falls on the insurance company in such cases.
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Since they were not able to provide an affidavit or a valid proof of any kind, the commission ordered them to pay the death claim along with 9% interest and extra charges.

Some insurance companies have started customizing their products to include mental health.
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But the country still has a long way to go before such claims are accepted without dispute.

What are your thoughts on this? Tell us in the comments below!
(9/9)

#BimaPeBharosa #India #Mentalhealth #insurance

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More from @BimaPeBharosa

11 Sep
How were army veterans in New Delhi cheated out of Crores?

The Army Group Insurance Fund (AGIF) was established in 1981 for providing Life Insurance cover to retired army personnel. It also comes with a medical benefit and a deposit scheme for deceased personnel’s family.
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But recently, the fund was targeted by a group of insurance fraudsters.

The group’s modus operandi involved reaching out to army veterans and claiming to help them receive monetary benefits from the fund.
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They guaranteed army pensioners and next of kin large amounts of money as outstanding maturities and bonus from the AGIF, and subsequently demanded an upfront payment of 30-40k as “processing fees” for releasing the amounts.
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10 Sep
How do Ganpati mandals protect their gold idols?

Happy Ganesh Chaturthi!

Ganesh Chaturthi is one of the most celebrated festivals across India. Each year the festivities span over 10 days and involve expensive Ganpati idols inside mandals laden with heavy gold ornaments.
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Leaving gold out in the open is obviously very risky. And this is why many of these mandals mitigate this risk by opting for insurance covers worth hundreds of Crores.

In fact, business skyrockets for insurance companies during these 10 days.
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They end up insuring over 100 big and small mandals for amounts ranging anywhere from ₹1 Lakh to a whopping ₹300 Crore.

For example, Mumbai’s wealthiest Ganpati mandal, the Gowd Saraswat Brahman (GSB) Ganesh Mandal took insurance worth ₹ 266.65 crore in 2019 alone.
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22 Jun
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(1/7)
The actual amount depends on how likely you are to require a payout in the future and how much your insurer might have to pay in such an event.

There are various factors that affect this amount:

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1) Your age: Health Insurance costs less in your youth. The older you get, the more likely you are to develop certain diseases- and so your premiums are higher.

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Let’s talk about Maternity #Insurance

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(1/5)
The reason is that Health Insurance covers unforeseen medical expenses, and getting pregnant is a very real possibility for most couples.

But don't fret- you can opt for maternity insurance as an add-on. This usually covers:

(2/5)
1) Hospitalisation, as well as pre and post-hospitalization expense
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3) Pre and post-natal expenses
4) Treatment expenses for children born with congenital conditions

Keep in mind:
1) Maternity Insurance is expensive as there is a very high claim ratio

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31 May
Why are room rent caps such a big deal?

Most Health Insurers place a limit on the amount you can claim for the rent of a hospital room. Usually, this limit is 1% of the total coverage.

(1/8)
Example- Mohan's health policy has a Sum Insured of ₹5 Lakhs and the Sub-Limit for hospital room rent is 1%. If Mohan is hospitalized, his insurer will only cover room rent costs up to ₹5000 per day (1% of ₹5 Lakhs).

(2/8)
If his room costs more than that, he’ll have to pay the difference himself. You may think that doesn’t sound so bad. He'd probably have to shell out a few extra thousands at most, right?

Wrong

Because room rent sub-limits also leads to proportionate deduction

(3/8)
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A few days ago, certain districts in Rajasthan and Uttar Pradesh sounded an alert for a possible locust attack.

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Locusts travel in large swarms of up to 80 million and can eat up to their own weight in crops every day. They wreak devastation wherever they go. And so, the farmers in these areas need to protect their crops however they can.

(2/6)
The last time Rajasthan saw a locust attack was in 2020. At the time, the state saw a 45% jump in enrolment for the government-sponsored crop insurance scheme Pradhan Mantri Fasal Bima Yojana (PMFBY).

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