Question: Insurance company has halted my policy even after receiving premiums and refusing to provide benefits. My wife has taken a medical insurance policy. She is a working lady and suffering from cardiovascular disease. The premium of policy has been auto renewed from her bank account. In the last premium there was some shortfall in the amount of money in her account.
Due to insufficient funds in her bank account the premium remained unpaid for five days. When she came to know that the premium was unpaid on the due date she manually paid the premium from her credit card.
The insurance company immediately sent payment receipt and a congratulation message on her email and mobile number also. Now she is facing medical complications and she approached the insurance company and she got information that her policy has been kept in halt. Sir, I want to take proper legal action against the insurance company.
Asked from: Tamil Nadu
The insurance company has accepted premiums with late fees. It shows that the insurance company has carried on the benefits of policy after imposing penalties in the payment of premiums.
In this situation the insurance company cannot say that it has halted your policy. It is incumbent on the insurance company to provide benefits of medical policy. Instead, the company is making false statements so as to disentitled you to get benefits.
You should file a complaint in the consumer forum. It is a deficiency in the service on the part of the insurance company. When the company has been accepting premiums it, later on, cannot say that policy is kept on hold.
The contract between the insurance company and you is valid and enforceable because the company has received consideration. Not providing medical insurance benefits to the policyholder constitutes act of fraud and deficiency in service.