Hence, I would advise you to intimate second TPA / insurer through a letter about submission of the original claim documents with first insurer as the reason for delay
My wife was hospitalised for 45 days. After discharge there was delay in receiving the documents as there were two TPAs involved. The first TPA paid full sum assured, but the hospital bill was higher. To claim the balance amount I applied to second insurance company. There was delay in submitting the documents as the first TPA had to handover copies of claims papers received from hospital. During this period the second insurer issued two reminder letters asking us to submit the claims documents. We informed them it will be done as soon as documents are received from the first TPA. We received a third letter saying that if the claim was submitted it will be rejected. On November 6 we submitted the entire file for balance amount of claim. Please guide us in this matter. Will my claim be paid?
– Jagdish Kamath
This is a usual scenario for claim under multiple policies. In such a situation, your second insurer / TPA will process the claim, after the first TPA/insurer settles the claim. Once that is done, the second TPA / Insurer will require the claim settlement letter from the first insurer. Hence, I would advise you to intimate second TPA / insurer through a letter about submission of the original claim documents with first insurer as the reason for delay. With a valid reason, the second insurer / TPA ideally won't deny to settle the balance amount, provided the claim is admissible as per your policy terms and conditions. Additionally, I would recommend you to buy a super top-up plan for your family which covers you if the sum insured of your base cover is exhausted. It is quite inexpensive and a better option rather than having two base covers.
I bought an expensive sports bicycle which I will use for adventure sports. Can I insure it? And will it be motor insurance?
Home insurance policies generally have a section exclusively for Pedal Cycles cover under which even your sports bicycle can be covered. Alternatively, you can also opt for a standalone pedal cycle insurance policy for the same, premium for which usually varies from 1% to 2% of the bicycle's value. Motor insurance is not applicable to a bicycle, although the cover is pretty much similar. Home insurance/standalone pedal cycle policy will pay for the repair or replacement costs of the bicycle caused by any unforeseen and sudden physical loss (like an Accident, Fire, Burglary, Flood, Cyclone, etc.). Insurer will also pay litigation expenses and compensation for any Third Party property damage/ Third Party injury or death, due to an accident involving the bicycle.
Since you are into adventure sports, I would also suggest you to opt for a personal accident cover which covers adventure sports. This policy covers death and permanent total disability due to accidental injury sustained while participating in adventure sports, with some insurers offering global coverage. While buying this policy you also need to check, whether it provides medical evacuation in isolated areas, because that is going to make a difference of life and death.
The writer is MD & CEO, Bajaj Allianz General Insurance
Send your queries related to general insurance to personalfinance@dnaindia.net.
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