ICICI Lombard General Insurance Company — non restoration of terminate policy vide no 40341/fpp/76087581/00/000

Address:

Bhopal, Madhya Pradesh

I was covered by ICICI Lombard health Care scheme from December 2009. The policy was renewed regularly. The above policy was valid for the period 15th December 2012 to 14th December 2013. During this period I was advisedly admitted in Paras Hospital, Bhopal from 2nd January 2013 to 4th February 2013. After discharge a mediclaim for an amount of Rs. 1, 31, 354/- was submitted along with supporting documents. This claim was rejected on the sole ground that I had submitted three estimate bills in place of cash bills and no medicines were purchased against this.As intimated by e-mail dt. 5th August 2013.I had then produced the original cash bills along with a letter from the chemist stating that actually the medicines were sold against the estimate bills and requested for a re-verification. The company agreed. While the process of re-verification was on and even before the claim was finally rejected the above policy was terminated on the same ground as mentioned above in September 2013, whereas the claim was finally rejected in December 2013. I then approached the Insurance Ombudsman in Bhopal for redressal. On 9th December 2014 before the Ombudsman the companbies representative gracefully withdrew the above mentioned allegation. Thus the ground on which the policy was terminated collapsed. He mentioned a new ground for rejection of the claim i.e. the patient had left hospital on two different days and claimed compensation for the entire period. It is a legally established norm that if a policy is proposed to be terminated on a particular ground and if that ground is proved to be wrong then the policy cannot be cancelled on a different ground. This would be against natural justice. Once the reason given for the termination was withdrawn by the accuser himself there remained no ground for termination. Thus the termination was virtually without any ground, hence arbitrary and void. In any case the hon’ble Ombudsman in his order has directed to settle the claim and has held that no fraud was involved in the claim. A copy of the order In view of the above facts of the case, sequence of events, judicial pronouncement the termination of the policy was illegal, therefore I requested it to restored immediately with retrospective effect from the date of termination vide my letter dated 15 april addressed to Branch manager Bhopal and copy to (ICICI Lombard General Insurance Co, Ltd. Ground & 4th Floor, Interface, 11, Office No. 401 & 402 New Linking Road, Malad (West), MUMBAI – 400 064. The policy has not been restored so far. I visited the branch manager several times and also send reminders to my request dated 15 th april 2015. I have also note received any response in the matter. all the documents in support of the facts stated above are with me Yours Faithfully Anthony Joseph Chacko [protected]/[protected] Email [protected]@rediffmail.com