My wife was operated for Aneurysm on 23/12/2010.Had submitted claim to an insurance company for stroke under subarachnoid hemorrhage(SAH).The company has following wording in the policy document.
Stroke - The first occurrence of an acute neurological event caused by a cerebral OR intracranial haemorrhage,cerebral embolism OR cerebral thrombosis where the following conditions are met :
1) There is an acute onset of the objective and ongoing neurological signs that are expected to be permanent and
11) Findings on the Magnetic Resonance Imaging,Computerused Tomography, or other reliable imaging teshniques, demonstrate a lesion consistent with the acute haemorrhage, embolism or thrombosis.Brain damage due to an accident,infection,vasculitis or an inflammatory disease are excluded.
The company has declined the claim giving the following reason --
Although the second condition of "Finding on Magnetic Resonance Imaging,Computerised Tomography or other reliable imaging techniques,demonstrate a lesion consistent with the acute haemorrhage, embolism or thrombosis" has been satisfy, the first condition of "acute onset of objective and ongoing neurological signs that are expected to be permanent" is not fulfilled.There is no evidence to suggest that the neurological signs are permanent.
All the qualifying conditions mentioned in the contract are required to be met for the claim to be payable, we regret our inability to honor this claim.
My question is
1) Is the company supposed to pay for the cause of the Critical illness OR for the After Effects as per their definition expecting some effects to be permanent
2) What kind of permanent neurological signs need to persist after stroke.With todays advancement in medical science can such effects be permanent if they were previously.
3)My wife has developed Blood Pressure after the operation and the doctor has advised medicine as an precautionary measure hence forth permanently.Can this be treated as permanent effect.
Kindly let me know your expert opinion since the claim has become more of basic principle now and will have to fight in the court of laws.
Thanx
Suraj
+91 92241 39975