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Empowering Families: A Case Study in Securing Deserved Compensation

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Case Study on Securing Rightful Compensation

Ramesh Gupta, a 38-year-old resident of Andheri, Mumbai, was the sole breadwinner for his family: his wife ( Sudha )  and two young children. As a responsible vehicle owner and provider, he had diligently insured his car to protect himself and his loved ones from unforeseen events. Unfortunately, Ramesh met with a fatal accident when a speeding truck collided with his car at the Andheri subway intersection. Despite his family submitting all necessary documents, they faced a setback when the insurance company denied the claim, stating that the circumstances of the accident were not covered under the policy.

Ramesh’s untimely demise left his family devastated as they were completely reliant on the insurance claim amount to meet daily monetary needs and sustain their livelihood going forward. However, to their dismay, the insurance company rejected the claim, arguing that accidents caused by collisions with heavy vehicles were not covered under the policy. This left Ramesh’s family ( wife and two children )  in severe distress, as they were counting on the insurance payout to provide them with financial support.

With no other means of financial assistance, Ramesh’s wife heard about Insurance Samadhan from her friend and decided to contact us for a resolution regarding claim rejection. She submitted all the documents and explained the case to our experts. After understanding the gravity of the situation, our team of experts investigated the circumstances of the accident and the policy terms to determine the grounds for rejection.

Upon thorough examination, it was found that the insurance company misinterpreted the policy terms regarding accidents involving heavy vehicles. The insurer claimed that such accidents were not covered, but a closer look at the policy revealed that collisions with other vehicles, regardless of size, were indeed covered.

They wrongly interpreted the clause regarding accidents involving heavy vehicles, assuming it excluded collisions with trucks from coverage. However, upon reviewing the policy, it was clear that the exclusion only applied to accidents caused by heavy vehicles in specific circumstances, such as intentional ramming or off-road accidents. Ramesh’s accident, a collision at an intersection caused by a negligent truck driver, clearly fell within the covered scenarios.

With the assistance of Insurance Samadhan, Mrs. Sudha – Ramesh’s wife, presented the above-mentioned explanation to the insurance company and re-filed the claim. This time, the claim was successful, securing the much-needed compensation for Ramesh’s family.

Conclusion 

Through diligent efforts and insurance expertise, Insurance Samadhan successfully overturned the insurance claim rejection. Ramesh’s family received the rightful compensation for the damages incurred in the accident, providing them with the financial support they needed during this challenging time. This case underscores the importance of understanding policy terms and seeking assistance when faced with insurance claim denials, ensuring that policyholders receive fair treatment from their insurers.

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