Section 26 in Rajasthan State Accredited Journalists Medical Facility Scheme 2009
26. Terms & Conditions.
- Every notice or communication to be given or made under this scheme shall be delivered in writing at the address of the TPA/GIF office.26.1The premium payable under this Policy shall be paid in advance. No receipt for Premium shall be valid except on the official form of the /SI&GPF signed by a duly authorized official of the/GIF. The due payment of premium and the observance and fulfillment of the terms provisions conditions and endorsements of this policy by the Insured Person in so far as they relate to any thing to be done or complied with by the Insured Person shall be a condition precedent to any liability of the GIF to made any payment under this Policy. No waiver of any terms, provisions, condition an endorsements of this policy shall be valid unless made in writing and signed by an authorized official of the GIF.26.2Upon the happening of any event which may give rise to a claim under this Policy notice with full particulars shall be sent to the TPA/GIF immediately and in case of emergency Hospitalization with in 24 hours from the time of Hospitalization.26.3All supporting documents relating to the claim must he tiled with TPA/GIF within 7 days from the date of discharge from the hospital. In case of post-hospitalization, treatment (limited to 15 days), all claim documents should be submitted within 7 days after completion of such treatment.26.4The Insured Person shall obtain and furnish the TPA/GIF with all original bills, receipts verifications and other documents upon which a claim is based and shall also give the TPA/GIF such additional information and assistance as the TPA/GIF may require in dealing with the claim.26.5Any medical practitioner or an officer authorized by the TPA/GIF shall be allowed to examine the Insured Person in case of any alleged injury or disease requiring Hospitalization when and so often as the same may reasonably be required on behalf of the TPA/GIF.19. The GIF shall not be liable to make any payment under this policy in respect of any claim if such claim be in any manner. fraudulent or supported by any fraudulent means or device whether by the Insured Person or by any other person acting on his behalf.26.6If at the time when any claim arises under this Policy, there is in existence and other insurance (other than Cancer Insurance Policy in collaboration with India Cancer Society), whether it be effected by or on behalf of any Insured Person in respect of whom the claim may have arisen covering the same loss, liability, compensation , costs of expenses, the GIF shall not be liable to pay or contribute more than its rate able proportion of any loss, liability, compensation costs or expenses The benefits under this Policy shall be in excess of the benefits available under Cancer Insurance Policy.26.7If and when the Insured has submitted his/her family details to the concerned State Insurance District office and identity cards have been issued to the insurer, then only he/she shall be entitled for cashless facility.26.8The Policy may be renewed by mutual consent. The GIF shall not however be bound to give notice that it is due for renewal and the GIF may at any time cancel this Policy by sending the Insured 30 days notice by registered letter at the insured's last known address and in such event the GIF shall refund to the insured a pro-rata premium for unexpired Period of Insurance. The GIF shall however, remain liable for any claim, which arose prior to the date of cancellation. The Insured may at any time cancel this Policy and in such event the GIF shall allow refund of premium at GIF's short period rate only (Table given here below) provided no claim has occurred up to the date of cancellation.26.9If any dispute or difference shall arise as to the quantum to be paid under the policy (liability being otherwise admitted) such difference shall independently of all other questions be referred to the decision of a sole arbitrator, to be appointed in writing by the parties or if they cannot agree upon a single arbitrator within 30 days of any party invoking arbitration, the same shall be referred to a panel of three arbitrators, comprising of two arbitrators, one to be appointed by each of the parties to the dispute/difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation Act, 1996. It is clearly agreed and understood that no difference or dispute shall be referable to Arbitration as herein before provided, If the GIF has disputed or not accepted liability under or in respect of this Policy. It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this policy that award by such arbitrator/arbitrators of the amount of the loss or damage shall be first obtained.26.10If the TPA, as per terms and conditions of the policy or the GIF shall disclaim liability to the Insured for any claim hereunder and if the Insured shall not within 12 calendar months from the date or receipt of the notice of such disclaimer notify the TPA/GIF in writing that he does not accept such disclaimer and intends to recover his claim form the TPA/GIF then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.26.11All medical/surgical treatments under this policy shall have to be taken in approved hospitals in and outside Rajasthan and admissible claims thereof shall be payable in Indian currency. Payment of claim shall be made through TPA/GIF to the Hospital/Nursing Home or the Insured Person as the case may be. The list of approved hospitals is available at (Annexure 2).26.12In case of death of insured during policy period the names of family members to be continued till expiry of the policy.26.13hi case of Group accidental insurance all conditions as laid down under accidental insurance policy at annexure shall be applicable.
