TTK Health Care Card not yet issued

I renewed my Health Policy with M/s United India Insurance on 20/01/09, however till today 13/07/09, I am yet to receive the TTK Health Care Insurance Card. I need the Card asap as this is the 6th month of the renewal

TTK Cards for Renewals not recved since 23/01/09.
Policy no: 072500/48/08/97/00001203, renewed policy on 23/01/09.
Insured Person : Mr Manoranjan Gupta – 35. Jayashri Benjamin – 34, Dev Gupta- 1.5

I Request the concerned authorities to please send me the cards in 2 working days.

regards
JAyashri Benjamin – 9880407680

Non Receipt of Claim Amount

My policy no is 282520007839 against which claim of Rs.75498/- was lodged in october-2007.They only paid me Rs29080/- & in spite of several mails letters & requests to all officials of Bhubaneswar, Kolkata & Third Party nobody even bother neither to pay me nor evening to reply till date. So I asked the help of Hon. Insurance ombudsman, Bhubaneswar & on 17th march 2009 Hon. Ombudsman issued order to Reliance to pay me the difference amount within one month from the date of decision. i.e by 17 th April 2009.But till date i could not receive the dues. Again so many mails & telephone calls have been made to Reliance office at Bhubaneswar & Kolkata but nobody is there to bother for me. They just ignored the decision of Hon. Insurance Ombudsman. Then I also requested Hon. Ombudsman through e-mail to help me for the same but their office could not help me for the same till date. I have lost 2 years for the said claim. Please help me & do the needful to get back my claim amount without further delay.

miselling of health insurance scheme

On 18-11-2009, I received a Call on my mobile and one of the executive told me that we are calling from ABN-AMBRO Bank, and our bank has chosen you to give a special scheme on health insurance from which you will get 1350000/- insurance cover . I told them that I was not holding any credit card of your bank, and the scheme you told me was for the ABN credit card holder only.

The executive told me that you could also take the advantage of this plan. I told them that I need a plan for my 75 years old dependant parents. He told me that we have this type of plan where your parents covered under that policy. I told them to send me the details of the policy and I need it for my parents only.

The executive told me that we have this type of policy for which you are required to give Rs.12457 as premium for 2 years and you can further pay us in monthly installments .Again I told them to send the details first. The executive told me that I am connecting the call to my other office and after you received the message in the phone, you punch your credit card no and you will get the complete details of the policy.

I told them that Iam not using your credit card, but they insisted to punch with your BARCLAYS CARD. I punched the credit card no on the telephone but it got rejected. Again they called me on the landline no to punch the card issued by Bank of Rajasthan. Immediately when I punched the credit card no on telephone, I received the one message that your transaction of Rs.12457 is complete. I told the executive that how he could do this without informing me.

He told me that you have 10 more days and we will send you the details of the policy, I CLEARLY TOLD THEM THAT I WAS NOT AT ALL INTERESTED IN THIS POLICY WITHOUT KNOWING THE FACTS AND FIGURES .YOU PLEASE CANCEL THE POLICY AND REFUND MY PAYMENT. He told me that OK WILL CANCEL THE TRANSACTION. I called the Bank of Rajasthan, credit card division, Mumbai for stop payment of transaction of Rs.12457/-immediately

Today, i.e. 04-12-09, I was shocked when I received the Policy NO 1304792825028205 for which I never interested. You can verify all the data from the executive or the discussion recorded. My request is to please cancel the policy with immediate effect and refund my whole amount without deducting any amount otherwise I have no other option except to go knock the door of court.

Regards

Sandeep Gargish

# 382-G, Shaheed Bhagat Singh Nagar

Pakhowal Road, Ludhiana

Mobile:-9814000642

Claim settlement

hi,

my mom shanta m boricha has a reliance health wise policy, its a cashless policy. she was hospitalized at a networked hospital for 8 days. According to policy terms & conditions any family member who stays with the patient at night gets 250 rupees per day i haven’t yet received the amount, and in spite of being a cashless policy the doctors are demanding consultation fees after every appointment so far she has been discharged now

Non-payment of medical claims

United Healthcare fails to approve payment of medical claims. Same claim has been submitted with all necessary paperwork and forms numerous times. This claim involves a second insurance plan that is considered primary. EOB’s from primary have been submitted, but every time they conveniently misplace one of the documents needed to complete the claim. They will not accept a fax while I am on the line with them so that it can be associated correctly. I am requested to resubmit the claim with all documents again, only to have United Health misplace some other document. It’s a never ending thing.

Mediclaim bill not settled and New Year cash less fax not replied

my dad has medical insurance from 2001 of 100000 which he had been renewing till date he got diagnosed for sugar and bp in 2002 in 2009 he got diagnosed for rectum cancer of me lignum mellonoma and got operated for the same and the bill shouted up to 2.5 lac of which at least the companies should have paid 1.3 lac but they simply paid 50000 …later he got admitted for heart problem and the hospital had cashless facility and the hos. Guys sent fax to the companies didn’t reply at all …new India and medi assist is no one cheats what should i do for claiming the money back

Oriental Insurance directed to pay compensation in mediclaim

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI

REVISION PETITION NO. 2745 OF 2003 (From the order dated 03.06.2003 in Appeal No. 169/03 of the State Commission, Jharkhand)

ORIENTAL INSURANCE COMPANY ……… Petitioner

New Delhi – 110001

Smt. Parkash Devi ……..Respondent

Jharkhand

BEFORE:

HON’BLE DR.P.D. SHENOY, PRESIDING MEMBER

HON’BLE MR. ANUPAM DASGUPTA, MEMBER

Order dated the 26th March, 2008 (excerpts only)

The complainant Smt. Parkash Devi took a mediclaim policy on 2.12.1997 by paying a premium of Rs. 1,554/- for a period of one year. Subsequently, her husband Bhagwan Das Agarwal and she jointly took a policy for one year (13.4.99 to 12.4.2000), which was renewed on 7.6.2000 with validity up to 6.6.2001. During the currency of this policy, Smt. Parkash Devi underwent an operation of the hernia. The claim filed was repudiated by the Oriental Insurance Company stating that under exclusion clause 4.3 during the first year of the operation of insurance cover the expenses on surgeries such as cataract, benign prosthetic hypertrophy, hysterectomy for menorrohia or fibryoma, hernia, hydrocele, congenital internal diseases, fistula in anus, piles and related disorders are excluded. The Insurance Company also contended that there was a gap of 55 days in renewing the mediclaim policy hence; it can only be construed as a fresh policy. Therefore, the exclusion clause applied to the mediclaim. Unhappy with the decision of the Insurance Company, a complaint was filed by the complainant before (respondent here) the District Forum, Ranchi.

The District Forum held that since the year of surgery was not the first year of the mediclaim policy of the complainant, she was entitled to the claim amount. The Insurer should not repudiate a claim mechanically and in a routine manner. The District Forum also held that such a view was supported by a decision of the Hon’ble Supreme Court “AIR 2001 page 549”. Accordingly, the District Forum directed the Insurance Company to pay (Rs. 6,257/- + Rs.1,379/-) i.e., Rs.7,636/- incurred by the complainant on her treatment during hospitalization.

Aggrieved by the order of the District Forum the Insurance Company filed an appeal before the Jharkhand State Commission, Ranchi. The State Commission, after hearing the parties, concurred with the decision of the Forum.

Dissatisfied with the order of the State Commission, the Insurance Company has filed this revision petition.

The main limb of the argument adduced by the Ld. Counsel for the petitioner is that there was a gap of 55 days between the expiry of the first mediclaim policy and issue of the fresh policy. The Insurance Company can condone 15 days delay only, not 55 days. Hence, the orders of the lower fora are erroneous as the policy issued on 17.6.2000 was a fresh policy. The exclusion clause is very much applicable.

As against this, the Ld. Counsel for the respondent showed us the mediclaim policy issued on 7.6.2000. In this, the Insurance Company has clearly mentioned previous year and policy No. as 2000 and 407. It has also mentioned that there is a family discount of Rs.255.50/-. He drew our attention to the prospectus issued by the Insurance Company under the Mediclaim – Hospitalization and Domiciliary – Hospitalization Benefit Policy wherein under the salient features of the policy, clause 1.3 reads as follows:

This insurance scheme also provides for:-

a) Family discount in premium (refer item 6)

b) Cumulative Bonus (refer item 9)

c) Cost of Health Check-up (refer item 10)

N.B. Renewal of insurance without break is essential. (Emphasis supplied)

It is a very clear-cut condition that family discount in premium will be given, provided there is a renewal of insurance policy without break. In this case, family discount in premium has been given because the Insurance Company acknowledged the fact of renewal of the insurance policy without break, i.e., having condoned the delay. Moreover, similar family discount was also given when the policy was renewed during the previous year but when the policy was taken for the first time, such discount was not given.

We have gone through the records and heard the arguments of both the counsel. The fact is that in the policy schedule which covered the mediclaim of Bhagwan Das Agarwal and Smt. Prakash Devi, there is clear mention of family discount which, according to the prospectus issued by the Company, is allowed only in cases of renewal of insurance policy without break. The only exclusion mentioned in the policy is as follows:

It is further declared and agreed that: – This policy specifically excludes any expense incurred towards treatment of AIDS Positive/AIDS cases

As the mediclaim in this case was not for treatment of AIDS the Insurance Company could not have repudiated the claim legally.

The Commission ordered that wherever the policy conditions are not clear and capable of more than one interpretation, the interpretation which is beneficial to the consumer should be adopted. Accordingly, the revision is dismissed. The Insurance Company is directed to pay Rs.25, 000/- as cost as the complainant was unnecessarily dragged to all the three consumer for to get legitimate benefits under the policy.

Bajaj Allianz refuse to reimburse the Mediclaim

I had purchased the mediclaim policy for me and my wife in the month of February last year from Bajaj Allianz Life Insurance Company Limited.

Further My wife has met with a road traffic accident on 12th February and was admitted in a hospital in Moradabad immediately in non networking hospital. Now when I am filing the case for reimbursement, the company is refusing to pay the claim, as they say that” PROCEDURE DONE (WOUND SUTURE UNDER LA) POSSIBLE ON DAY CARE BASIS. HENCE, CLAIM FOR HOSPITAL STAY NOT ADMISSIBLE OR PAYABLE”

The claim no. for Medicare tpa services (I) pvt ltd is 03102578 under policy no. 0122060967 from Bajaj Allianz life insurance corporation ltd. Member ship no. is BAFCF069449B SHUBHI ROHATGI Please advise. Thanks Tanuj Rohatgi

Tanuj Rohatgi

Location: Ghaziabad, UP, India

Email: tanuj@looxx.in

Mediclaim Reimbursement

I have submitted my claim Insurance of Rs 1, 16,266 on dated 09 November 2009 and also submitted relevant documents as required by Medi Assit on 09 December 2009. The reference is CNN # 4471968.
It is regret to note that till date there is no communication from any concern on my claim from Insurance company or TPA.

My claim is pending from since last 5 months due to the negligence / fault of RGICL and TPA (MediAssist).

Now when I am calling them they are not picking my phone nor are they replying my mail.

It is hereby requested to please guide what will be my next step for early settlement of my above claim.

Any reply on guidance will be highly appreciated.

TATA AIG Medical Insurance Fraudulent

Dear All,

I am running a TATA AIG medical insurance policy from two years. At the time of insurance giving me TATA AIG executive told me if got admitted in hospital you are applicable to claim, I asked any kind of problem take care by this policy that time executive told me YES.

My wife was got admitted in hospital on 03/02/2009, I am trying to register a claim the executive told me this is not possible because your policy have different kind of rules. So i want to know why they are told me you can claim anything at time of policy given to me or anybody.

 Please help me.

 If I know this thing, then why continue with this kind of policy.

 This is totally fraudulent done with me by TATA AIG.

 Please do the needful.

 My Policy no. is MRP11000002572.

 Thanks & Regards

Shashikant Sharma

9891948822