Confused About Medical Insurance Coverage After a Car Accident? Need Your Insights!

Hi All,

Would appreciate if you can help me with this. We are providing medical insurance for our employees through a Medical Insurance Company. One of our staff got into a car accident while he was a passenger (not a driver) outside of working hours, going to visit some relatives. However, we have submitted the pre-approval authorization, but the reply was that the pre-approval was rejected since it is considered Third Party Coverage. They mean that medical insurance doesn't cover such types of treatment, and it is the responsibility of the car insurance to cover such an incident. However, the car insurance was expired at the date of the accident. I have looked at the policy and contract with the insurance company, but I couldn't find any mention of this situation.

I would appreciate it if you could let me know about this, as it seems strange to me and illogical. For example, if we had a staff bus carrying 25 staff that met with an accident, then none of the staff would be covered by the insurance.

Thanks,
Yallashop

Hi, Please check whether the medical insurance provided by you covers accidental insurance. If it is covered, you may write to the regional manager of your insurance company. If you do not receive any positive reply, you may take up the matter with the Insurance Regulatory and Development Authority.

Hi,

Normally, medical insurance should cover any hospitalization expenses following an accident during travel in India, provided that:

1) the person (driver) is not under the influence of alcohol/drugs at the time of the accident
2) there should be hospitalization for more than 24 hours.

The insurance company cannot wash their hands of the matter in this case. You should take up the issue with the issuing office.

Jose

Dear YallaShop,

Mediclaim covers hospitalization due to accidents. You need to support the accident by an FIR and prove that the employee was not under the influence of alcohol, and the injuries were not a result of violence. A standard Mediclaim will cover any hospitalization due to accidents.

Regards,
Dr. Venkatesh
9880370989