| Address: 712201 |
| Website: www.bajajfinserv.in/finance |
Arup das 255/14, n. S. Road
Po-sheoraphuli
Ps-serampore
22.10.2017 dt-hooghly, pin-712223
The bajaj allianz general insurance co. Ltd
Ge plaza, airport road
Yerwada, pune-411006
Non-sanction of claim for motor insurance: case of arup das, vide private car package policy no. Og[protected]-00000007[claim id no. Oc[protected]-00007706].
Sir
At the outset, this is to inform you that i have long been a bona fide customer of bajaj mediclaim insurance, bajaj finance loan, bajaj durable consumer loan and two-wheeler insurance, apart from bajaj private car package insurance as noted above.
So far i have not only been an avid and integrated customer of the bajaj allianze, but also a satisfied customer to convince my acquaintances and relatives to go for you in their times of necessity for being insured on any front as above as offered by you.
But a sudden quirk of fate has changed my perception and seriously shaken my trust in your company which is narrated below.
On 05/08/2017 morning, i was met with an accident by a speeding truck on national highway at nabagram under burdwan-ajhapur top in jamalpur ps area at burdwan. Instantly after getting over the preliminary shock, i called from mobile no.[protected] on your toll free no.[protected] of a local resident, reporting the accident. I was told that your representative would come visiting the spot within half an hour.
But none came either at the spot of accident or at the ps. The car was towed by the police to the police station; and after investigation by them and examination and receipt of report submitted by the mechanical expert referred by jamalpur ps, they released it on zimmanama after 10 days to be towed away on my own to bhandari automobiles, a maruti service station where it is being kept till now @rs.300/- per day as garage charge.
However, by the gracious intervention of the almighty, i was saved, though my maruti alto[wb16ae0863] was badly damaged beyond recognition.
The police duly submitted their report citing my driving licence for the four-wheeler which i was holding at the time of the accident.
But despite assuring me by your representative over phone that the claim would be settled within 15 days, nothing of this sort happened.
Rather, vide email dated 21/09/2017 from mr ashwani chouhan/kolkata/claims/motor/general on behalf of your company, i was informed that my claim could not be sanctioned in view of my holding a separate two-wheeler driving licence in my name, an information which i erroneously shared with your person over phone, when he asked for the dl no. Of the 4-wheeler for reconfirmation to settle the claim.
It is informed to me that as per prevalent mv rules, i need to be in occupancy of a combined dl for both 4-wheeler and 2-wheeler, instead of separate ones.
This was a body blow to me.
Now, in view of the above, i want to put forth my case on the following points.
First, i have never defaulted on any front so far as the conditions laid down in the said policy of mine are concerned.
Second, as per your own written stipulation, i was holding an effectively valid driving licence which was duly mentioned by and incorporated in the police report.
Third, nowhere in the proposal form of the policy, i was asked to certify myself or mention against any item of query/information that i was holding a combined or a separate dl for two-wheeler and four-wheeler.
Now, when it comes to make good for the huge loss i have suffered on the force of the said insurance, your people are walking away from the stipulated norms and conditions as noted in the policy as well as within the purview of the insurance act into the motor vehicle act to decline my genuine claim on a flimsy ground not of their concern at all, nor within their jurisdiction.
As to holding separate licence, i have been holding the same since 2001.
Not only i did not know about any such rule, a majority of the people i encountered after receiving such shocking information declining my claim on this flimsy ground don’t know either.
If there had been any such pre-condition in settling claim issues, there ought to have been such clause or provision in the proposal form for the proposer to fill in.
Besides, this separate holding of dls does in no way related to the insurance and conditions thereof.
It is a clearly sinister stratagem by your people to deprive the insured of their genuine claim even after satisfying all conditions laid down in the policy.
What is more, your people defaulted by not undertaking the mandatory spot-verification and assisting me to reach the damaged vehicle from the spot of immobilization to the nearest preferred workshop as the event occurred within 100kms from the centre point of my residence, which is clearly stipulated in the said policy booklet provided to me along with the policy.
So, when you yourselves have failed to abide by your own set rules, you are not authorized to question the technicalities about holding dl by walking into mv rules not specified either in your proposal form or in the policy.
I think, the company representatives are up to defaming and depopularizing this feted company and playing into the hands of your rival ones for some hidden benefits.
In view of the above, i beseech your good senses to please immediately settle my claim as due to me without wasting further time, failing which i will not only pursue the matter legally, but also take recourse to the social media, making people wary of being insured with your company in future.
As to renewal of my two-wheeler insurance, i will be the last person to visit your premises, if this claim is declined once and for all.
Thank you.
22.10.2017
Yours sincerely
Arup das
Following emails received from your representatives —
Fwd: claim i'd oc[protected]-00007706
Oct 11 (11 days ago)
To me
— forwarded message —
From: "souren das/vso joka/profit centre/general"
Date: 21 sep 2017 17:09
Subject: fwd: claim i'd oc[protected]-00007706
To: "[protected]@gmail.com"
Cc:
Fyi
Souren das
Territory manager
Vso joka
[protected]
— original message —
From: ashwani chouhan/kolkata/claims motor/general
Date:21/09/2017 16:01 (Gmt+05:30)
To: souren das/vso joka/profit centre/general
Cc: jay kumar/kolkata/profit centre/general, mahendra ghorpade/ho-direct marketing/profit centre/general, raj kumar/kolkata/profit centre/general, sagir gogoi/kolkata/claims motor/general, chandan chowdhury/kolkata/claims motor/general
Subject: re: claim i'd oc[protected]-00007706
Dear souren ji,
As per the claim intimation & documents provided by insured, dl is not valid for the class of vehicle. (Authorized to drive 2w only)
Secondly, insured providing another dl copy which is valid for the class of vehicle and as per the rule, one person cannot carry 2 driving license.
Due to this reason we are unable to admit this claim.
Thanks & regards
Ashwani chouhan
M - [protected]
From: souren das/vso joka/profit centre/general
Sent: thursday, september 21, 2017 3:54 pm
To: ashwani chouhan/kolkata/claims motor/general
Cc: jay kumar/kolkata/profit centre/general; mahendra ghorpade/ho-direct marketing/profit centre/general; raj kumar/kolkata/profit centre/general; sagir gogoi/kolkata/claims motor/general; chandan chowdhury/kolkata/claims motor/general
Subject: re: claim i'd oc[protected]-00007706
Dear ashwiniji,
Kindly update about this claim, because customer and agent both are following up for this continuously.
Souren das
Territory manager
Vso joka
[protected]
— original message —
From: chandan chowdhury/kolkata/claims motor/general
Date:20/09/2017 19:13 (Gmt+05:30)
To: ashwani chouhan/kolkata/claims motor/general
Cc: jay kumar/kolkata/profit centre/general, mahendra ghorpade/ho-direct marketing/profit centre/general, raj kumar/kolkata/profit centre/general, souren das/vso joka/profit centre/general, sagir gogoi/kolkata/claims motor/general
Subject: re: claim i'd oc[protected]-00007706
Dear ashwani,
Please check and update.
Regards.
Chandan.
[protected]
From: raj kumar/kolkata/profit centre/general
Sent: wednesday, september 20, 2017 7:02 pm
To: souren das/vso joka/profit centre/general; sagir gogoi/kolkata/claims motor/general; chandan chowdhury/kolkata/claims motor/general
Cc: jay kumar/kolkata/profit centre/general; mahendra ghorpade/ho-direct marketing/profit centre/general
Subject: re: claim i'd oc[protected]-00007706
Dear souren,
Please follow the escalation matrix & coming forward don’t mark any mail directly to amc.
Dear chandan,
Please update the current status of said claim.
Best regards
Raj kumar
[protected]
From: souren das/vso joka/profit centre/general
Sent: 20 september 2017 18:28
To: sagir gogoi/kolkata/claims motor/general
Cc: jay kumar/kolkata/profit centre/general; raj kumar/kolkata/profit centre/general; mahendra ghorpade/ho-direct marketing/profit centre/general
Subject: re: claim i'd oc[protected]-00007706
Dear sir,
Inspection of this claim was done few days ago, but till now customer have not received any communication from our side. Everyday customer is calling the agent for the claim status, this imd is a regular good business depositer. Kindly communicate what is the status of the claim, and where it is pending.
Regards
Souren das
From: souren das/vso joka/profit centre/general
Sent: wednesday, august 09, 2017 2:08 pm
To: sagir gogoi/kolkata/claims motor/general
Cc: jay kumar/kolkata/profit centre/general
Subject: claim i'd oc[protected]-00007706
Dear sir,
This claim was lodged by customer few days ago, till date no response from our side. Kindly confirm the customer when we will send somebody for claim survey.. Some pics of the vehicle are attached here. Please follow up urgently.
Souren das
Territory manager
Vso joka
[protected]
Nov 24, 2017
Complaint marked as Resolved
Bajaj Allianz customer support has been notified about the posted complaint.
Verified Support
Oct 24, 2017
Bajaj Allianz Customer Care's response Hi Souren,
We've noted your concern and escalated the same to our team. Be assured, we'll get in touch with you soon to address your concern.
Your case is registered under the Reference No. BA - 1283. Please mention the same in the subject line of the email for future follow ups. Thank you.
Regards,
Bajaj Allianz Genera Insurance
We'll get this checked for you. Please share your contact number at [email protected]. so that we can get in touch with you at the earliest.
Also, we've registered your case under the Reference no.: BA - 1302. Do mention the same in the subject line of the email while sending in the details.
Regards,
Bajaj Allianz General Insurance
PRAMOD SINGH <[email protected]>
10:30 AM (1 minute ago)
to vishal.agale01
---------- Forwarded message ----------
From: PRAMOD SINGH <[email protected]>
Date: Sat, Nov 25, 2017 at 7:48 PM
Subject: Fwd: FW: Ragini Singh /Claim Number-OC-18-1002-6021-00002906
To: [email protected]
Dear sir,
Please tell me who has confirmed that the hospitalization was because of hypertension, as per my understanding it was due to high blood pressure. Is it excluded under the policy and if so please let me know ?
Now it's high time and after 4 days left completing 2months this is the explanation.
I am not at all satisfied with this, and this reply is also due to regorous follow up from my end not from your side.
What is the settlement time and in order any clarification who is responsible and what is the deadline.
And after 2 months saying that the case is closed I am not going to tolerate.
Let me know what action you are going to take.
Also if not please advice
Thanks and Regards
Pramod Singh-7506963754
---------- Forwarded message ----------
From: "Health Admin/Head Office Pune/HAT/General" <[email protected]>
Date: Nov 25, 2017 17:23
Subject: FW: Ragini Singh /Claim Number-OC-18-1002-6021-00002906
To: "[email protected]" <[email protected]>
Cc: "Document Recovery/Head Office Pune/HAT/General" <[email protected]>
Dear Sir/Madam,
Good Evening
With reference to your below email, we regret to inform you that claim has been repudiated because of following reason:-
Sr No
Claim ID
Claim No
Claim Type
ID Card No
Partner Id
Patient Name
Claim Status
1
1497832
OC-18-1002-6021-00002906
REIMBURSEMENT
18-84646850
82153323
RAGINI SINGH
CLOSED
· Verification of the claim document reveals the aforesaid claimant was hospitalized for the treatment of Accelerated Hypertension in a k/c/o Cervical Disc Prolapse and Hypothyroidism. We regret to inform you that the claim stands repudiated as the policy does not extend coverage for any expenses incurred on the treatment of Hypertension and its complications during the first two years.
Regards,
Supriya Gagare
Health Administration Team
Bajaj Allianz General Insurance Company Ltd.
If you are not satisfied with the response, you may escalated it to :– [email protected]
In order to view claim status, kindly click on link:- https://general.bajajallianz.com/BagicNxt/InHouseSP/hm/externalUserCC.jsp
Claim status on SMS: Type CSTATUS <space> ID Card NO and send to 9773500500
You may also live chat while clicking on link:- https://chat.botplatform.io/bot/bot_1493214269480
From: Document Recovery/Head Office Pune/HAT/General
Sent: Saturday, November 25, 2017 1:49 PM
To: Health Admin/Head Office Pune/HAT/General
Cc: Ashish Kadam/Ho Hat/HAT/General
Subject: FW: Ragini Singh /Claim Number-OC-18-1002-6021-00002906
Dear Sir/Madam,
Greetings for the day
Pdn
Thanks & Regards,
Jidnyasa Alhat
|Document Recovery Team
For Health Claim status mail mark to ([email protected])
—————————————————————————
Bajaj Allianz General Insurance Company
2nd Floor, Bajaj Finserv Building,
Behind Weikfield IT park,
Off Nagar Road, Viman Nagar
Pune 411014| Toll free: 1800-103-2529, 1800-22-5858
For Health Claim status on SMS: Type CSTATUS <space> ID Card NO and send to 9773500500 or log onto our website www.bajajallianz.com
From: PRAMOD SINGH [mailto:[email protected]]
Sent: Wednesday, November 22, 2017 9:25 AM
To: Document Recovery/Head Office Pune/HAT/General; Ragini Singh
Subject: Re: Ragini Singh /Claim Number-OC-18-1002-6021-00002906
To,
Whom so ever it may concern,
With regards to the trail mail and the claim Id:- 69618486, its been a long time since the
reimbursement is unpaid and i am expecting the claim team to settle within a week.
Reagrds
Pramod Singh-7506963757
[email protected]
On Thu, Nov 16, 2017 at 2:05 PM, PRAMOD SINGH <[email protected]> wrote:
To
Bajaj General Insurance
This is with respect to the claim made under the mediclaim policy with policy no.
OG-18-1000-6021-00009876, against ID-Card:-18-84646850, patient name:-
RAGINI SINGH.
I have submitted all the documents relevant to the hospitalization
to the Pune branch and also received the confirmation on 27th sep., next there was a message received on 9th oct 2017 acknowledgement of processing the claim.after that there has been no call or messages or email received for the claim or any discrepancy.
On 22nd of oct(Sunday) evening i received a call from one of the company executive named Mr. Dhirendra Dubey, saying that he needs to visit our home take statement of the patient, when i asked him is it a standard process because i have not heard it before, he arrogantly replied do i come or not? .
Finally i asked him to come although i had to settle this faster.
In the statement the patient has clearly mentioned that this is the first instance and the ailment is diagnosed or reported to her by the doctor for the first time.
At the same time the executive has asked for the first consultation, which we have mentioned in the statement also its Dr.Dilip K Koparde, then he said that he has not received that consultation personally(over which i have replied that the hard copy is already sent to the Pune address though if you want i can mail you the soft copy), he said okay mail it me.the very next morning i had sent him the soft copy,
After 4-5 days i received again a call from him asking when it was diagnosed then i said we already mentioned in the statement and the date is mentioned on the consultation paper.(At the same time i asked him i mailed you the document as promised very next day in the morning-23rd oct, again he replied arrogantly that this is not the only thing he has got to do.)
In the interim till 13th Nov. i have been tried contacting with the various means of contact, i had called on the customer care no., one girl picked up the phone and said the claim is under process, there no such discrepancy reflecting in the system and it takes a months time after under process so you wait till 9th of nov(i said okay and finally disconnected).
On 13th Nov.17 i have received the call and the mail on the discrepancy is this the correct time to ask for it(attached the same).
To whom so ever it may concern
1.Do let me know on what ground the client is been treated.
2.after taking a coverage for a well known co. like BAJAJ for 10Lacs
how will i keep trust for future if this is the experience for a small claim of 18394/-
3.also just for reference attached are the documents for which the originals submitted to the Pune branch office.
4.Please refer to the attachment file named "hospitalization papers" page no. 12 which is the first and the only consultation paper which we have got with us and the same time i.e 31st Sep 17 the ailment was reported to us also.(repeating again which Mr. Dhirendra Dubey has taken in signed from us as a statement on 22nd Oct Sun evening) .
For attachment please find the trail mail
Awaiting for the advice
Thanks & Regards
On behalf of Ragini Singh
Pramod singh-7506963754