[Resolved]  Oriental Insurance Co — denied the cashless claim

Dear Sir,

I the above mentioned holding policy no. 163600/48/2008/2626 in Pune DO IV, will like to complaint about the claim part. I am holding the policy for last 5 years and first time I had requested for the claim for hospitalization of my mother who had a severe pain in her back and she was not able to get up from bed neither move on either side while sleeping or make any movements.

I had to hospitalized her for same after taking a proper letter form a MD doctor in Pune she was hospitalized on 17th night, aft having MRI and NCv test doctor came to a conclusion that the case is critical and surgery would not help so patient has to continue rest and oral medicine along with the physiotherapy treatment which was given in hospital for 4 days after that doctor suggested to take the patient at home and continue the same as there was little development with patient.

In mean time I requested for cashless first I was wrongly informed by Raksh that they have not received any fax from hospital when I cleared that the fax is already sent, the lady Dr Meghna asked for proofs I had to give them all the details with proofs then hey told me to fax the latest copy of Insurance which was already faxed to them. When I told the lady about same she told me that fax me all the copies from the day I have taken insurance she told me to fax the copies for last five years I told her that I am in hospital and no body will carry last five year copies. she got angry about this and she told me that she will see to it that i do not recive the calim.

And further to that after coordinating for whole day my claim was denied after giving all the details of policy and line of treatment and papers the claim is denied, saying that the there was no reason to admit the patient it was not severe.

I tried to take help from oriental insurance DO, Manager & regional Manager but nobody wanted to help me in this case.

Please advice legally how can i fight all this people togther