[Resolved]  Oriental Insurance Co Ltd — Long Delay in settlement of claim

Address:

West Delhi, Delhi

Dear Sir

I'd like to put forward my complaint against Oriental Insurance Co Ltd & Medsave Healthcare Ltd (TPA) who have been showing very callous attitude towards settling the mediclaim for my husband's policy.The claim no. is 4101127B001R21. The claim filed in 8th Sept'2010 (bills submitted worth Rs 3,90000 was to be settled for 2,30000/-) got settled on 19th April'2011 (for 2,23000/-) after my husband's death on March 15th' 2011 after repeated reminders to the agent & mails/ph calls to the regional office at Laxmi Nagar. There had been no response to my mails marked to the Regional Heads of Oriental Insurance Ltd & the TPA's. I'm attaching the mails marked to them to portray the clear picture.The claim settled & response to the difference not paid is not to my satisfaction.They are not able to explain the delay & the difference in the amt of claim. I'm higly disappointed with the attitude of the company & the TPA's & would like to claim the interest on the account of late payment.

THE LETTER MAILED TO REGIONAL HEADS IS AS FOLLOWS :

Regional Head Oriental Insurance Ltd./
Regional Head Medsave/
Regional Head E-Meditek Services Pvt Ltd

Dear Sir,

With great dissatisfaction & after waiting for a long time to get a reply & claim payment, i am forced to write a mail to you. I had submitted a claim in the month of September 2010 on the name of my husband Manish Sahni against claim no. 4101127B001R21. I got a reimbursement of Rs 223096 through a cheque in first week of January 2011 made on HDFC A/c while i'd given the A/c no of Bank of Baroda. The covering letter stated that the department had not received bills worth Rs 149862. I mailed the concern of the claim being settled for less amount(RS 7000) as i'd submitted all the bills. I submitted the cheque back for correction on 9th Jan'11 & mailed this concern to Ms Geeta & Dr Adish on 12th Jan'11. Dr Adish mailed back a reply stating he's forwarded the mail to Ms Geeta who'll revert back.
I've pasted the mail sent by me on 12th Jan at the end of this mail for your reference.
Till date i've received no reply from anybody in regards to either the payment or the missing bills.
During this period my husband passed away on 15th March'11. So when i enquired in first week of April about the corrected cheque i was told by my agent that now the cheque will me made on the nominee's name i.e my name. For the same he took an application & my husband's death certificate on 5th April & said that he'll get the cheque in a day or two. On 9th April he tells me he needs an Affidavit stating that i'm Manish Sahni's wife & the only legal heir. He got the same signed from me on 12th April & said that the cheque is already made on your name which i'll be collecting tomorrow. Then on 13th he said cheque is made everything is done but the audit is going on so cheque cannot be issued, it'll be issued on 15th as 14th is a holiday. Now today on 15th at 5:22 pm he called me up & said i'm waiting for the RM since morning as he's to sign the cheque, he's not come so you'll get it on monday.
Then he made me speak to a genleman at Laxmi Nagar Office.
When i spoke to the Deputy Manager, Mr Ramkishan at Laxmi Nagar Office he said that "cheque correction mein time lagta hai, pehle use bank jaake stop karana parta hai phir naya banata hai, itna time toh lag hi jaata hai aur aapka cheque monday ko Balram le jaayen"
He very arrogantly & rudely said that you can go to the court to claim the interest on your reimbursement not maid on time.
I want to ask Oct,Nov,Dec -3 months for a cheque to be made against a claim. Then 9th Jan to 15th March i.e 64days for a correction cheque & still the work not done?????
I'm very disappointed with the way department is working.
I'm waiting for a satisfactory response in settlement of the claim at the earliest else i'll be forced to go to the ombudsman.

MY FIRST MAIL TO DR ADISH / MS GEETA

Subject:Querry regarding claim no.4101127B001R21
From:"Shivani Sahni"<[protected]@rediffmail.com>Wed, 12 Jan 2011 21:31:34
To:"[protected]@medsave.in"<[protected]@medsave.in>

Dear Ms Geeta/Dr Adish

I've received a letter dated 31.12.10 against claim no.4101127B001R21 on the name of Manish Sahni. This letter states that billsamounting Rs 149862 were not enclosed at the time of submission. All the bills were duly submitted along with the discharge summary.My mediclaim agent has all the details & the bill nos submitted while i have their scanned copies. If you require any of them do let me know so that i canforward them & get the full mediclaim amount which asper me is Rs 7000 less than the policy claim.
Also the cheque has been made on HDFC A/c while i'd given the A/c no of Bank of Baroda. I've already given a letter in this regard to my mediclaim agent. Please look into the matter and extend your support at the earliest.

Best Regards
Shivani Sahni
[protected]

REPLY FROM DR ADISH

From: "Dr. adish" <[protected]@medsave.in> Thu, 13 Jan 2011 13:04:10
To: You and others

Dear Geeta,

Two things to be worked upon -

1. verification of bills actually submitted

2. correct bank details to be updated

Pl revert as soon as the issue is resolved and also communicate to the insured accordingly.

Regards.


----- Original Message -----
From: P Malhotra
To: Adish
Sent: Thursday, January 13, 2011 9:51 AM
Subject: Fw: Querry regarding claim no.4101127B001R21

NO RESPONSE SINCE 13th Jan' 2011.