Published in Mint on 16 February, 2016, Written by Abhishek Bondia
I live in Chennai and during the floods last year, I was stuck in the rains in my car. It stopped mid-way in a partially submerged lane and wouldn’t start. When I claimed for the repair, the insurance company refused to pay my claim as I had tried to start my car in water. What should I do?
—Venkatesh Pillai
The kind of claim you are describing seems to be that of engine seizure. When the car is submerged, and you try to start its engine, water is pulled into the suction pipe. If water goes into the engine, it leads to seizure. Hydrostatic lock or engine seizure due to water is excluded under standard motor insurance. The driver is expected to not restart the car if it stops while submerged. Numerous claims get rejected due to this exclusion, and this is often contested in courts. If you can establish the fact that this was done to minimise the overall loss, and you had no other alternative, the insurer may be willing to reconsider.
Several insurers now offer ‘hydrostatic lock’ as a separate extension. This in effect nullifies the exclusion. Under motor insurance, several other add-ons are available such as zero depreciation, loss of keys, roadside assistance, and tyre burst.
I recommend that when buying a motor insurance policy, consider these add-ons. Generally, the cost of such add-ons is marginal, and they go a long way in ensuring smooth claim settlement.
I have health insurance from my employer which covers me, my wife and my parents. My parents had gone to Vaishno Devi on pilgrimage and my father suffered a stroke. He was hospitalised and treated in a hospital in Jammu as his condition was too critical for him to be brought back to Delhi, where we live. That particular hospital is not covered by the insurance company but its branch in Delhi is, where he was referred to later. But the insurer has refused to honour the claim as that particular branch was not covered. How can I make a claim in this situation? The policy allows for both cashless and disbursal against claim.
—Govind Saxena
Most medical insurance policies cover cashless as well as reimbursement claims. If the treatment is done in a network hospital of the insurer, the claim is settled as a cashless claim. If the hospital is not part of the insurer’s network, you should intimate the insurer immediately after hospitalisation. After discharge, you can submit original bills and treatment papers to the insurer, which will then settle the claim through direct transfer to your bank account.
Based on the case described, the insurer cannot reject a claim simply because the hospital is not part of the network. You should, however, check if all the other policy conditions were fulfilled, i.e., minimum 24 hours of hospitalisation, hospital is licensed and the claim was intimated in time to the insurer
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