Medical Insurance – Premium increased after just one claim

Problem: Medical Insurance – Premium increased after just one claim

Solution: Premium should increase only on recurring claims and not on the possibility of recurring claims. Talk first to the insurer through letters. If no reply, contact insurance ombudsman. Decision of insurance ombudsman is binding

 

Detail

Q: I have a family floater policy since the last 6 years, renewable every 2 years, for 5 Lakh. Three years ago, I made a claim for my wife. At that time the premium was around 1200 per month for our 4 member family including me (52), wife (49) and two kids (15,9). In January 2010, when the renewal was due, the company increased the premium to around 2000 per month. I have not made any claim in the last two years. Will the premium reduce now?

Solution:

It is wrong on the part of the insurance company to load the premium after the first claim. Insurers generally load the premium if there are recurring claims and not if there is a possibility of recurring claims.

 

You should write to the insurer asking it to reduce your premium to the amount mentioned in its charts. In case you do not receive a reply, which I doubt you will, write another letter mentioning that you will take up the matter with the insurance ombudsman if the insurer does not correct the anomaly. Subsequently, you should take up the matter with the insurance ombudsman and lodge a complaint. Send all communication by registered address.

 

I feel the ombudsman will direct the insurer to reduce the premium. The ombudsman's decision is binding on the insurer.