Published in Mint on Nov 17, 2016, Written by Abhishek Bondia
I have a motor insurance policy. If I install a music system in my car during the policy period, will that be covered?
—Ankit Moranha
The music system installed in your car can be covered if you inform the insurer and pay an additional premium. The insurer will issue an endorsement to you that specifically mentions the music system. The additional cost of insurance will be around 4% of the cost of the music system.
I am a cardiac surgeon looking to buy professional indemnity insurance. Can you tell me a little bit more about it?
—Pradeep Sharma
Professional indemnity insurance will cover you against litigation by your patients. The scope of the cover is the loss suffered by your patients due to alleged professional negligence. These include patients suing for negligent diagnosis or administration of a sub-standard course of treatment. The policy pays for lawyer’s fees to defend yourself and compensation if awarded by the court.
The insurance does not cover wilful acts. While buying a policy, be mindful of three aspects: select an appropriate level of sum assured, ensure that the full policy sum assured can be utilized in any one accident, and evaluate add-on covers. The extent of medical malpractice suits has increased rapidly. There have been a few instances where claims of several crores have been awarded. While adjudging compensation, courts look at the loss of potential income of the patient right up to their retirement.
You should choose a sum assured based on your client profile and your specialty. Surgeons and anesthetists are most prone and need the highest sums assured. In professional indemnity insurance for doctors, some insurers have a practice of limiting the sum assured available for a particular accident to a fraction of the overall sum assured. This is done via the clause of Any One Accident: Any One Year (AOA: AOY). Insist on an AOA: AOY of 1:1.
You should consider add-on covers to the core professional indemnity insurance. These add-ons help override some of the exclusions of a standard policy and broaden the coverage. Examples of add-ons are loss of documents, breach of confidentiality, dishonesty of employees, libel, and slander.
My mother is 58 years old and has a mediclaim policy that is 7 years in running. Only one claim was made. I plan to increase the cover amount next year but with another insurer, as the present insurer has hiked the premium steeply. How should I go about it?
—Arun Taneja
Medical insurance allows portability, which means you can switch to another insurer without losing the benefit of the lapsed waiting period with the incumbent insurer. If another insurer offers a lower premium, you could apply to it for portability, two months before your renewal date. You would also need to make an application to your current insurer requesting a shift to the new insurer.
You should inquire about the reason for the increase in premium with your incumbent insurer. Insurers can only increase renewal premiums based on age. The Insurance Regulatory and Development Authority of India does not allow insurers to do claims-based loading in individual health policies.
I am going to France for 4 months and have taken travel insurance. If needed, how do I make a claim?
—Karim Khan
In case of a medical emergency, you can claim under travel insurance via the insurer’s local cashless network. Most insurers have international tie-ups through which they are able to access a network of hospitals abroad. If you visit a network hospital, you can avail of the cashless facility by presenting your travel insurance policy.
If you visit a non-network hospital for medical claims, or for any other claim such as loss of passport, you would need to file for reimbursement. You should inform the insurer immediately upon loss. Intimation could be via phone or mail. The insurer would send you a list of documents to file for reimbursement of the loss. In cases involving a third party, such as theft, you must report the incident to local authorities as well. After you come back to India, you can submit these documents to the insurer. The claim will be paid out in Indian rupees after adjusting the deductible specified in the insurance.
