[Resolved]  Mdindia Healthcare Services — Non payment of hospitalisation claim

Mediclaim Policy No. 150100/48/09/[protected] of National Insurance Company, India
TPA Service Provider - MD India Healthcare Services (TPA) Pvt. Ltd. (MD 15-[protected])
I have claimed a Hospitalization claim for an amount of Rs.22451.68 to MD India Healthcare Services (TPA) Pvt. Ltd. for death claim of my Brother-In-Law Sri Jaydeep Chattopadhyay and submitted all the required documents and Indemnity, surety desired by the TPA with the signature of my elder sister as she is the only legal heir. The claim was lodged on January 2011 and the same has been processed with further documentation on 21.04.2011 (copy enclosed). My Brother –In-Law died on 05.01.2011 but we are not getting the claim amount though we have submitted all the required papers and documents as they have asked. More surprisingly the NIC had released the claim amount through claim control no. 874045. The TPA is not issuing the cheques and repeatedly saying that the authorized signatory is not present, cheque date has not mentioned. Harassing us. Actually NIC does not have any control on this TPA. I have lodged complain to IRDA also through Reg. No.[protected] dated 25.05.2011 but there is no result. Actually IRDA also does not have any control on TPA. Most of the TPA uses the claim settlement funds for the payment of Cash Less but the Insurance Companies does audited the claim settlement and cheque issuing to the claim holder. Sometimes the TPA also issue the cheques in the name of party but does not deliver the cheque to hold the funds and to meet their cash less payments. This is cheating with the Policy Holders. My question is why we are being cheated by the Mediclaim Policy. This is shame to NIC & IRDA that they do not have remarks and action on that. I will place the matter to the higher forum for justice and mental harreshment.

Somnath Ganguly