FAMILY MDDICLAIM POLICY

I am 40-year-old diabetic. My wife is 37 and child seven. Am I eligible to take a family mediclaim policy?
You can certainly secure a family mediclaim policy for your family. Since you are already suffering from diabetes, it will be excluded from the scope of the policy. Your wife and child can have a normal cover according to the terms and conditions of the policy, which you choose.

PLEASE GUIDE ME

I have bought a house in Delhi. What kind of insurance should I look at?

You need to ensure the building and the contents of the house. For the building, you can take a separate policy, covering the risks of fire and allied perils. You can also add a cover for earthquake. Alternatively, you may buy a comprehensive householders’ policy. This covers the building and also its contents against various risks. You can also cover your electrical equipment against the risk of breakdown. Jewellery and other valuables can be covered against all risks, including loss within the geographical territory of India.

INDEMNITY POLICY

What does a professional indemnity policy for lawyers include?
Professional Indemnity policy issued to lawyers, advocates, solicitors and counsels is basically meant to cover liability falling on them as a result of errors and omissions committed by them while rendering professional service. The policy covers all sums, which the insured professional becomes legally liable to pay as damages to a third party in respect of any error and/or omission on his/her part committed while rendering professional services. Legal cost and expenses incurred in defence of the case, with the prior consent of the insurance company, are also payable, subject to the overall limit of indemnity selected. The policy, however, covers only the civil liability claims. Any liability arising out of any criminal act, or act committed in violation of any law, is not covered. The sum insured under the policy is referred to as the limit of liability in a professional indemnity policy. This limit is fixed per accident and per policy period, which is called any one accident limit and any one year limit, respectively.

RAILWAY COVER

Does railways give cover to its passengers? If yes, what kind of cover is it?

Yes, the railways does provide personal accident insurance cover to the passengers. The cover is provided to bone fide passenger ticket-holders, platform ticket-holders and season ticket-holders. Children up to the age of five years, who are not required to buy tickets, are also covered, provided they are travelling with ticket-holders. The compensation for injuries sustained varies between Rs 32,000 and Rs 4 lakh as defined in the schedule of injuries under the Railways Act, 1989. The policy covers all the passengers in the railway premises. For any unscheduled injuries, the compensation of up to Rs 80,000 may also be given. The compensation amount is decided by the Railways Claims Tribunal. Once the claim is decided by the tribunal, the insurance company reimburses the claim amount to the railways.

INSURANCE OMBUDSMAN

I want to file a complaint against my insurance company for the mental agony I have suffered due to the inordinate delay in the settlement of an insurance claim, which necessitated, among other things, repeated visits to its office. What is the procedure for filing a complaint with the insurance ombudsman?

First, you need to approach the insurance ombudsman under whose jurisdiction the servicing office of the insurance company against which you want to complain falls. The complaint must be in writing and accompanied by the documentary evidence of the circumstances giving rise to the dispute, nature of loss sustained and relief sought from the ombudsman.
The ombudsman will first try to settle the dispute through mediation between the parties involved. If a settlement is reached through mediation, he will make recommendations as he deems fit, within one month from the date of receipt of the complaint.
If the complaint is not settled through mediation, the ombudsman will pass an award, which he thinks is fair in the light of the facts and circumstances of the complaint. Such an award is passed within three months from the receipt of the complaint. If the award is acceptable to the complainant, in this case you, the insurance company needs to comply with it without fail. If the ombudsman deems fit, he may award an ex-gratia payment.

FLOATER POLICY

My son is admitted to a hospital for a heart problem. My husband’s medical policy provided by his company is covering part of the expenses. Will our family floater policy cover the remaining expenses? Can two policies be used together for a single expenditure?
Both the medical policies can be used simultaneously for the same incident of disease. In fact, under the terms of all insurance policies, you are obliged to disclose the details of all the policies operative on the day of hospitalisation.
All mediclaim policies pay the insured in the proportion of the sum insured under respective policies. You can file the claim under any of the policies mentioning the particulars and the sum insured under the other policy. The insurers will automatically share the claim amount between them.

NO CLAIM BONUS TRANSFER

Can a no-claim bonus on a health policy be transferred from one insurance company to another?
A no-claim bonus is a discount given by insurance companies to the insured at the time of renewal of policy if the insured has not filed any medical expenses claim in the last one year. A no-claim bonus is given either as a discount in the premium or as enhanced cover without the incremental increase in premium. In this way, insurance companies also build customer loyalty towards them.
If you take a fresh medical insurance policy from a new company, you cannot get a no-claim discount as a matter of right. Insurers, however, do consider pervious history with the other insurance companies and give suitable discounts to attract new customers.