[Resolved]  Bajaj Allianz — policy lapsed with false reason

Please advice on the below email communication

PRAMOD SINGH <pramod2284@gmail.com>
10:30 AM (1 minute ago)

to vishal.agale01

---------- Forwarded message ----------
From: PRAMOD SINGH <pramod2284@gmail.com>
Date: Sat, Nov 25, 2017 at 7:48 PM
Subject: Fwd: FW: Ragini Singh /Claim Number-OC-18-1002-6021-00002906
To: [email protected]

Dear sir,
Please tell me who has confirmed that the hospitalization was because of hypertension, as per my understanding it was due to high blood pressure. Is it excluded under the policy and if so please let me know ?
Now it's high time and after 4 days left completing 2months this is the explanation.
I am not at all satisfied with this, and this reply is also due to regorous follow up from my end not from your side.
What is the settlement time and in order any clarification who is responsible and what is the deadline.
And after 2 months saying that the case is closed I am not going to tolerate.
Let me know what action you are going to take.
Also if not please advice
Thanks and Regards
Pramod Singh-7506963754

---------- Forwarded message ----------
From: "Health Admin/Head Office Pune/HAT/General" <[email protected]>
Date: Nov 25, 2017 17:23
Subject: FW: Ragini Singh /Claim Number-OC-18-1002-6021-00002906
To: "pramod2284@gmail.com" <pramod2284@gmail.com>
Cc: "Document Recovery/Head Office Pune/HAT/General" <[email protected]>

Dear Sir/Madam,

Good Evening

With reference to your below email, we regret to inform you that claim has been repudiated because of following reason:-

Sr No
Claim ID
Claim No
Claim Type
ID Card No
Partner Id
Patient Name
Claim Status
1
1497832
OC-18-1002-6021-00002906
REIMBURSEMENT
18-84646850
82153323
RAGINI SINGH
CLOSED

· Verification of the claim document reveals the aforesaid claimant was hospitalized for the treatment of Accelerated Hypertension in a k/c/o Cervical Disc Prolapse and Hypothyroidism. We regret to inform you that the claim stands repudiated as the policy does not extend coverage for any expenses incurred on the treatment of Hypertension and its complications during the first two years.



Regards,
Supriya Gagare
Health Administration Team
Bajaj Allianz General Insurance Company Ltd.

If you are not satisfied with the response, you may escalated it to :– [email protected]
In order to view claim status, kindly click on link:- https://general.bajajallianz.com/BagicNxt/InHouseSP/hm/externalUserCC.jsp
Claim status on SMS: Type CSTATUS <space> ID Card NO and send to 9773500500

You may also live chat while clicking on link:- https://chat.botplatform.io/bot/bot_1493214269480

From: Document Recovery/Head Office Pune/HAT/General
Sent: Saturday, November 25, 2017 1:49 PM
To: Health Admin/Head Office Pune/HAT/General
Cc: Ashish Kadam/Ho Hat/HAT/General
Subject: FW: Ragini Singh /Claim Number-OC-18-1002-6021-00002906



Dear Sir/Madam,

Greetings for the day

Pdn

Thanks & Regards,
Jidnyasa Alhat
|Document Recovery Team
For Health Claim status mail mark to ([email protected])
—————————————————————————
Bajaj Allianz General Insurance Company
2nd Floor, Bajaj Finserv Building,
Behind Weikfield IT park,
Off Nagar Road, Viman Nagar
Pune 411014| Toll free: 1800-103-2529, 1800-22-5858

For Health Claim status on SMS: Type CSTATUS <space> ID Card NO and send to 9773500500 or log onto our website www.bajajallianz.com




From: PRAMOD SINGH [mailto:pramod2284@gmail.com]
Sent: Wednesday, November 22, 2017 9:25 AM
To: Document Recovery/Head Office Pune/HAT/General; Ragini Singh

Subject: Re: Ragini Singh /Claim Number-OC-18-1002-6021-00002906

To,
Whom so ever it may concern,
With regards to the trail mail and the claim Id:- 69618486, its been a long time since the
reimbursement is unpaid and i am expecting the claim team to settle within a week.

Reagrds
Pramod Singh-7506963757
pramod2284@gmail.com


On Thu, Nov 16, 2017 at 2:05 PM, PRAMOD SINGH <pramod2284@gmail.com> wrote:
To
Bajaj General Insurance

This is with respect to the claim made under the mediclaim policy with policy no.
OG-18-1000-6021-00009876, against ID-Card:-18-84646850, patient name:-
RAGINI SINGH.
I have submitted all the documents relevant to the hospitalization
to the Pune branch and also received the confirmation on 27th sep., next there was a message received on 9th oct 2017 acknowledgement of processing the claim.after that there has been no call or messages or email received for the claim or any discrepancy.
On 22nd of oct(Sunday) evening i received a call from one of the company executive named Mr. Dhirendra Dubey, saying that he needs to visit our home take statement of the patient, when i asked him is it a standard process because i have not heard it before, he arrogantly replied do i come or not? .
Finally i asked him to come although i had to settle this faster.
In the statement the patient has clearly mentioned that this is the first instance and the ailment is diagnosed or reported to her by the doctor for the first time.
At the same time the executive has asked for the first consultation, which we have mentioned in the statement also its Dr.Dilip K Koparde, then he said that he has not received that consultation personally(over which i have replied that the hard copy is already sent to the Pune address though if you want i can mail you the soft copy), he said okay mail it me.the very next morning i had sent him the soft copy,
After 4-5 days i received again a call from him asking when it was diagnosed then i said we already mentioned in the statement and the date is mentioned on the consultation paper.(At the same time i asked him i mailed you the document as promised very next day in the morning-23rd oct, again he replied arrogantly that this is not the only thing he has got to do.)
In the interim till 13th Nov. i have been tried contacting with the various means of contact, i had called on the customer care no., one girl picked up the phone and said the claim is under process, there no such discrepancy reflecting in the system and it takes a months time after under process so you wait till 9th of nov(i said okay and finally disconnected).
On 13th Nov.17 i have received the call and the mail on the discrepancy is this the correct time to ask for it(attached the same).

To whom so ever it may concern
1.Do let me know on what ground the client is been treated.
2.after taking a coverage for a well known co. like BAJAJ for 10Lacs
how will i keep trust for future if this is the experience for a small claim of 18394/-
3.also just for reference attached are the documents for which the originals submitted to the Pune branch office.
4.Please refer to the attachment file named "hospitalization papers" page no. 12 which is the first and the only consultation paper which we have got with us and the same time i.e 31st Sep 17 the ailment was reported to us also.(repeating again which Mr. Dhirendra Dubey has taken in signed from us as a statement on 22nd Oct Sun evening) .

For attachment please find the trail mail

Awaiting for the advice

Thanks & Regards

On behalf of Ragini Singh


Pramod singh-7506963754