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Thread: Cause of hospitalization

  1. #1
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    Arrow Cause of hospitalization

    I have a health insurance with New India Assurance Co Ltd covering both of us, husband and wife.
    Both are senior citizens.
    Recently my wife had a very unfortunate and nasty accidental fall from a step of a temple causing serious fracture to her right femur shaft. She had a very serious and complicated surgery, intramedullary interlocking nailing , by an orthopedic surgeon.
    After discharge from hospital, she is now recuperating at home.
    Now the problem arises to fill up the claim form for reimbursement of the expenses incurred during hospitalization.
    For cause of hospitalization, three options, (i) injury, (ii) illness and (iii) maternity, are mentioned.
    Common sense suggests 'injury' in this case.
    If that option is taken, then as cause of injury three option are mentioned.
    , viz, (i) self inflicted, (ii) road traffic accident and (iii) substance abuse/alcohol consumption , none of which appears relevant here.

    Or, in health insurance definition 'self inflicted injury' includes accidental fall induced injury as well ?
    And in that case, will the claim be admitted ?
    Please, clarify.



  2. #2
    Super Moderator PolicyWala's Avatar
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    Default

    Quote Originally Posted by Cygnus_A View Post
    For cause of hospitalization, three options,
    (i) injury,
    (ii) illness and
    (iii) maternity, are mentioned.

    Common sense suggests 'injury' in this case.

    If that option is taken, then as cause of injury three option are mentioned.
    , viz,
    (i) self inflicted,
    (ii) road traffic accident and
    (iii) substance abuse/alcohol consumption
    I am not able to see above question in claim form (http://newindia.co.in/downloads/Medi...Claim-Form.pdf)

    Are you able to upload that here so that we can see what they are asking?

    Self Inflicted Injury - means "inflicted by oneself upon oneself".

  3. #3
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    Quote Originally Posted by Cygnus_A View Post
    I have a health insurance with New India Assurance Co Ltd covering both of us, husband and wife.
    Both are senior citizens.
    Recently my wife had a very unfortunate and nasty accidental fall from a step of a temple causing serious fracture to her right femur shaft. She had a very serious and complicated surgery, intramedullary interlocking nailing , by an orthopedic surgeon.
    After discharge from hospital, she is now recuperating at home.
    Now the problem arises to fill up the claim form for reimbursement of the expenses incurred during hospitalization.
    For cause of hospitalization, three options, (i) injury, (ii) illness and (iii) maternity, are mentioned.
    Common sense suggests 'injury' in this case.
    If that option is taken, then as cause of injury three option are mentioned.
    , viz, (i) self inflicted, (ii) road traffic accident and (iii) substance abuse/alcohol consumption , none of which appears relevant here.
    Or, in health insurance definition 'self inflicted injury' includes accidental fall induced injury as well ?
    And in that case, will the claim be admitted ?
    Please, clarify.
    If it is possible for you to upload a copy of your form so we will have a look on it. Well claim in such cases are admitted

    1.if your wife has been hospitalized due injuries related an accident for more than 24 hours.
    2. Check whether the health insurance plan covers the injuries related to accident. However for that you need to clarify the terms and conditions of policy.

  4. #4
    Banned
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    Nov 2015
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    Hi,
    The claim will be accepted if you submit the same under 'self inflicted injury'. There will be no problem from the Insurance company in accepting the same


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