[Resolved]  National Insurance Company — Med.Claim

Date: 12th Mar, 09

Office Of The insurance
Ombubsman
Chandigarh



Reg. Policy No. 361102/48/07/[protected]


Dear Sir

We have taken our mediclaim policy from M/S NATIONAL INSURANCE COMPANY LTD. from last 4-5 years without any break.

Last year on very first instance, when I came to know the severe pain in my left kidney and I believe that due to some stone particles. This later on diagnosed by the doctors also. I immediately admitted to the nearest hospital i.e. Sarvodya Hospital on 27th May 2008. I was till there on 28th May 2008, therefore again for the same problem admitted on 31st May 2008 and discharged on 3rd June 2008 (the cashless approval was granted by Vipul for the said stay and whole treatment, which was not cured at Sarvodya Hospital). As the stone position in the kidney area was critical to operate there in the hospital, hence the hospitals officials called the doctors from outside for their valued opinion and after their mutual discussion, my family members were called and advised that since we do not have the sufficient machine / instrument to operate on that particular portion, where the stone is lying, advised my family members to take me to the Sharma Nursing Home, Faridabad, which has the expertise to resolve these types of critical cases, as they are having their in house facilities through their special and latest technology / machines for operating such types of critical cases.

Therefore, that was the time when we were not in position to even think more for any other option and proceeded as per the doctors’ advice. Upon these facts and position, I was taken and admitted by my family members in Sharma Nursing Home, Faridabad on 4th June 2008 and operated there and discharged in normal health condition on 9th June 2008.

At last I had submitted my claim for reimbursement of money spent by me to National Insurance Company and National Insurance Company refusal letter dated 22nd August 2008 came to me stated that the hospital where you have been treated, is not in our list of Hospitals.

Now, we are facing big problem for related to claim. National Insurance harasses us from last 7-8 months. When we have taken this policy there is not in hospital list. After when they do start limited hospital lists. They have not given us any information through courier or any source. . Every 3 months or 6 months they are changing hospital lists and give not any information to customer.

So, how can we update about it. Sir, right now we are in financial crises. We have gone to National Insurance at least 100 times form last 8 months. They have sent our case in their R. O. Office. They rejected also become of hospital. Our problem is genuine. We told them to check it out. But they harass us continue and misguide also. Please clear our case as soon as possible. They had already passed 40-50 cases as per our cases. Because some customers are relative of insurance Company’s employees. But they rejected our case without any reason. The Manager of National Insurance Mr. Kaul & Mr. M K Dhariwal have no answer about our case. They always said “your case is OK” But R.O. has rejected the file. They have advised us to go to R.O... We are already wasted our lot of time, Money and Fuel also. We are regularly disappointed by them. Now there is no way out to approach to you people. This is our humble request you to clear our case and make the Cheque of our Claim and our fuel expenses if it is possible.

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Sir, my humble request to you is that please look in to the facts of case and kindly accord your approval, So that the reimbursement is made available to me at the earliest. I am again enclosing a copy of all mediclaim policies Photocopy and rejection Letter of Insurance Company for your ref.

Kindly take a necessary action immediately


Thanking You


Yours truly,

Jagdish Sikka
889/1, Raja Garden
Old Faridabad.


Encl.: as above