[Resolved]  Bajaj Allianz — student travel plan og[protected]

Address:

Pune, Maharashtra

Incident took place in december 2016.
Since then i have sent whatever info/details asked for.
Now they are offering only 50% despite the fact that the policy holder has full insurance, they are saying it was a pre-existing condition, which it was not as well as the fact that even if it was pre-existing, the policy terms and conditions state that the insurance company is still expected to pay the full claim.

I wish to draw your attention to various facts.

1. Kamya sud has full travel insurance.

2. She has no pre-existing disease.
As you know that uti is not a pre-existing condition.
Even pcod is not a disease, it is a common health problem affecting 5-10% of the female child bearing age population. Please see below.

What is polycystic ovary syndrome (Pcos)?
Polycystic ovary syndrome (Pcos), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With pcos, the egg may not develop as it should or it may not be released during ovulation as it should be.
Pcos can cause missed or irregular menstrual periods. Irregular periods can lead to:
Infertility (Inability to get pregnant).in fact, pcos is one of the most common causes of female infertility.
Development of cysts (Small fluid-filled sacs) in the ovaries
Who gets pcos?
Between 5% and 10% of women of childbearing age (Between 15 and 44) have pcos.1 most often, women find out they have pcos in their 20s and 30s, when they have problems getting pregnant and see their doctor. But pcos can happen at any age after puberty.
There is no cure for pcos, but you can manage the symptoms of pcos. You and your doctor will work on a treatment plan based on your symptoms, your plans for children, and your risk for long-term health problems such as diabetes and heart disease. Many women will need a combination of treatments, including:
Steps you can take at home to help relieve your symptoms
Medicines

3. She was misdiagnosed with pcod before she left india in august 2016. She did not take the yanci that was prescribed and instead had an iud inserted in november 2016. Details of which have already been sent to you.

4. You are fraudulently only quoting part of the terms and conditions of the policy. You are deliberately trying to mislead and misrepresent to a client which is illegal and tantamount to fraud.

"in consideration of the payment of additional premium, it is hereby agreed and declared that section 2 “medical expenses & medical evacuation” of the travel prime student plan is extended to cover the medical and related expenses incurred by the insured in a hospital outside india for medical treatment of pre-existing illnesses provided the hospitalization has occurred during the policy period and provided that maximum liability of the company will be limited to the amount specified in the schedule under the optional cover pre-existing illness coverage.in consequence where of exclusion appearing as below in the travel prime student plan document:
The company shall be under no liability to make payment hereunder in respect of any claim directly or indirectly caused by, based on, arising out of or howsoever attributable to:
“any medical condition or complication arising from it which existed before the commencement of the policy period, or for which care, treatment or advice was sought, recommended by or received from a physician” stands deleted"

You have conveniently left out the key fact that it stands deleted.

So even if this was a pre-existing condition, you are bound to pay the claim in full as per your terms and conditions.
Items #2 and #3 proves that anyway it was not a pre-existing condition.

5. Please note that offering the client 50% of the claim, saying that you are giving the client "benefit of the doubt" when she is entitled to the full claim is completely unjustified and i will take up this matter with both the consumer courts and the ombudsman and take this further with all the directors of the company as well as the stock exchange, sebi and the economic times as proof of the unethical behavior of your company. If this matter is not cleared within 7 days from the date of this mail.

Looking forward to a speedy resolution of this matter.
Regards
Zia sud
For kamya sud