Medical Claim rejection by Niva Bupa

S

Shnair123

New member
Policy Name
Aspire
Company Name
Niva Bupa
Customer Care Number
1800 3010 3333
Loss Amount
79000
Ratings
3.00 star(s)
Opposite Party Address
KALABHAM, VALIYAVILA LINE, AVANAVANCHERY PO-695103, ATTINGAL
TRIVANDRUM DISTRICT, KERALA
Dear Sir / Madam,

Myself Santhosh Harindran Nair who is a policy holder from Niva Bupa Insurance Co. I have recently ported my health insurance from Care Insurance to Niva Bupa convinced on the extra benefits which Niva claims that will be provided. I ported this policy on 24 rth Dec, 2024 and I had raised a medical claim for my son who was admitted at Ananthapuri Hospital for a surgery in his neck area to remove a cyst. The same was diagonised on 11 th Jan, 2025 after we consulted a nearby doctor and he suggested to take a US Scan. In the scanning report there was a cyst and doctor suggested to operate the same. Based on his words we met Dr. Jayakumar @ Ananthapuri Hospital and he fixed a surgery with in next 02 days. We placed the claim during admission and during the time of discharge we had to pay an amount of Inr. 79000/- as hospital bills as Niva team rejected the claim saying that it was not disclosed during porting the policy. How can I declare a disease which was found after 1 month of inception of new policy ??? Please help me to get this claim asap.
 
I'm sorry to hear about the challenges you're facing with your medical claim to Niva Bupa. It's essential to understand that insurance claims can be denied for various reasons, including non-disclosure of pre-existing conditions, incomplete information, or policy exclusions. In your case, the claim was rejected on the grounds of non-disclosure during policy porting.

Steps to Address the Claim Rejection:
  1. Review the Rejection Reason:
    • Understand the Basis: Carefully read the rejection letter to comprehend the specific reason for denial and share it.
    • Policy Terms: Refer to your policy document to verify the terms related to pre-existing conditions and disclosure requirements. And if not found anything relevant to your case, kindly share it.
  2. Gather Supporting Documentation to file a case:
    • Medical Records: Obtain all medical reports, including the diagnosis date and doctor's recommendations, to establish the timeline of the ailment.
    • Communication Records: Keep copies of all correspondence with Niva Bupa regarding the claim.
For further assistance or professional guidance, consider consulting our legal expert specializing in insurance claims to help navigate the process effectively.

Thanks
 
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