Insurance Guru: 'Insurer won't pay complete claim'

Roopam Asthana, CEO and whole-time director, Liberty General Insurance Ltd, answers your queries about HEALTH insurance and AUTO insurance.

Abel Correa: I had taken auto insurance for a 2-year-old car (XUV 500) and, during the sales cycle, the insurance agent convinced me to buy bumper to bumper insurance rider + zero depreciation rider.

Now, six months ago my car met with a minor accident and the front left tyre suspension assembly had to be replaced. The service centre quoted Rs 18,000 which I agreed to. Here is where the problem of understanding and agreements came into play.

The insurer at first refused to give the Rs 18,000 claim and, after heated arguments, they deducted Rs 5,000 and paid the difference to the service centre.

My queries are:

a. As I had taken zero depreciation cover, is it not that I get to claim full Rs 18,000 plus bumper to bumper rider being there in place. Was told by the insurance call centre that the ball joint part of the front suspension assembly was consumable and hence not reimbursable.

b. How does one correct such a way of thinking? Does the consumer court entertain insurance claim loopholes whereby things get corrected over a period of time for a better world tomorrow?

Looking forward to hear from you a fair opinion as I may be wrong here and misunderstood the policy and I will be careful in paying extra for the riders.

Roopam Asthana: About your problem:

a. There are add-ons that an insurer can offer to the customer which will cover the risks that are traditionally not covered in a standard policy.

For example, depreciation cover will only provide the coverage for the deduction of depreciation amount applicable at the time of claims on replacement of parts/paint material cost. It will not cover the other standard deductions such as consumables, salvage, etc.

Further there are deductibles like compulsory deductible or any additional deductibles (if any) imposed at the time of policy issuance which will be deducted at the time of claims.

b. It is important that the insurance agent explains the coverages and exclusions in detail at the time of selling a policy to the customer.

This is extremely important and critical so as to minimise any customer dissatisfaction.

Moreover, the customer also needs to thoroughly read the policy wordings along with the terms and conditions mentioned under the policy schedule to understand the complete coverages offered for the policy.

Sanjiv Madhukar Kakade: While taking the health policy of Star Health, we went for a medical check-up and in the medical check-up it was found that both of us, ie husband and wife, were having hypertension.

Hence, the insurer said the waiting period for any problem arising due to hypertension will be four years. Is there any company where I can take a policy and the waiting period will be less?

Roopam Asthana: As per the definition, any medical condition diagnosed prior to purchasing a policy is considered as 'pre-existing'.

You may check the insurance plans that are available in the market with lesser waiting period for pre-existing medical conditions.

There are plans that cover pre-existing with a short wait period which could be less than two years too.

You may opt for such products after discussing with your insurance advisor.

Do you have health or auto insurance queries? Please mail your queries to getahead@rediff.co.in with the subjectline Ask Roopam and he will answer all your health insurance and auto insurance queries.

Feature Presentation: Ashish Narsale/Rediff.com