Contribution Clase in claims made from multiple health Insurances

POSTED BY abhinav ON September 10, 2013 8:31 am COMMENTS (2)

Hi Experts,

I have a group health insurance from my employer of Rs 2L. i have bought a seperate cover of Rs 5L individually. Now here is the query:

If, lets say, i make a claim of 6L, then none of the individual insurance would pay the entire sum. So can i make a claim of 5L from my personal cover and the remaining 1L from the company insurer??

I was assuming that this would be the logical way to interpret this, until i stumbbled upon the concept of the “contribution clause” wrt making claims from different/multiple insurers. I did not undersatnd how exactly this whole clause works. Hence the query.





2 replies on this article “Contribution Clase in claims made from multiple health Insurances”

  1. Dear Abhinav, for you, the total sum assured is 2-5 = 7L Rs. So for a total claim amount of 6L Rs. both the insurer ‘ll pay the claim in 2:5 ratio.



    1. Mustafizur Rahaman says:

      Normally this is mentioned (ration wise claim) explicitly in your policy certificate. If this is not mentioned, you should check with your insurance company.

      Also remember in such cases, total 6L may be coming from 1 bill, but you can’t produce 1 original bill to 2 insurance companies. In that case, you need to submit the original bill to the company you are claiming maximum, & copy of the bill should be attested by them, which you can then submit to the 2nd insurance company.

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