India hospital pandemic Health rights India

Need to protect rights of policyholders with high-value health covers

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₹1 crore to covering treatments abroad, high networth individuals (HNIs) have a lot to choose from. However, the rights of such policyholders need better protection.

The grievance redressal mechanism is a good example. All personal-focused insurance policies list the insurance ombudsman as the adjudicator for claim disputes between the insurer and insured.

Such listing is irrespective of the sum insured. In reality though, the ombudsman adjudicates claims only up to ₹30 lakh. So, in case the claim amount exceeds this threshold, the policyholder has to look at other forums such as the consumer court.

Most policyholders are not aware of this nuance. In case of a dispute, they are more likely to follow the rules laid down in the policy.

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