Hyderabad: The Consumer Forum says that claims cannot be rejected because of failure to inform of hospitalisation in case of a medical emergency. A mediclaim policy requires the insured to intimate the insurance company or the TPA about hospitalisation. However, at times of medical emergencies, the priority becomes to get the patient admitted and treated, not waste time in finding the policy to send intimation about the hospitalisation. In such cases, the insurance company attempts to capitalise on the non-intimation clause and reject the claim. This is not permissible, as recently held by the South Mumbai District Consumer Forum in the case of Consumer Welfare Association & Anr v/s United India Insurance Co & Anr.

J. Harinaryana, former chairman, IRDA, stated, “Individuals covered under group policies have had their claims rejected on technical grounds like slight delays in intimation of claims. IRDA has advised insurance companies that contractual conditions should not prevent them from considering genuine claims. This is especially if unavoidable circumstances prevented the consumer from following some of the policy conditions like time-frame for intimation.”