Cnbc Awaaz — Complaint Against Cholamandalam general insurance company for Rejected Covid 19 reimbursement claim

Address:

claim department ,baroda sun tower,Bandra-kurla , Mumbai 51

Dear Sir,
I Requested to you please accept my complaint against Cholamandalam general insurance company regarding they are not providing Mediclaim reimbursement claim
of Rs. 171799/- against.
I availed Hospitalization treatment for diseases of corona positive (covid-19).
I have a availed a Group Mediclaim insurance sum insured of ₹ 750000/- with policy from CHOLA MS GENERAL INSURANCE COMPANY. ( Bankainsurance )Through Bank Of Baroda. on dated 14th October 2019 and after renewal in 14 oct 2020 .

I had submitted REIMBURSEMENT claim for covid 19 ( Corona +) availed treatment for hospitalization and company was denied / rejected my Reimbursement claim with reason of Pre Existing Disease - Diabetic / Hypertension Disease Not mention in our policy record

This Reason are not valid or Void for Rejection of my Covid 19 claim. due to I have not put the claim or taken treatment of Diabetics or hypertension or same related disease.

Also In this claim settlement process I confirm that I had not Including or availed treatment from hospitalization and not claimed of any pre Existing Disease or related Medicine / Lab Diagnostic Bills.

Also this policy was taken from Employee of Mr Aakash Patel -CG Road Branch Ahmedabad who take care of BOB Mediclaim Business and he was visited at my home & at time of taken policy and I Explained my Mother Existing Disease. after when I had received First Policy copy and seen Existing Disease Colum mark as " NA " & also as same repeat at time of Renewal of Policy same Not mention Existing Disease. at both time.

After I confirm with Mr Akash and he was replied that don't worry Diabetes & H.P.T and or related disease are not covered up to 2 years of in this policy but Except this others all General & Accidental or Natural Calamity Disease are covered under this group Mediclaim policy. And Existing Disease are covered after completed 2 years of Issued / availed policy.as per terms.

In first and 2 nd both years in policy existing disease are not mention and both time I discussed talk with Employee of company Mr Aakash patel but he was not take seriously this error. Also I have purchased another Policy in name of My Father on same date along with this my mother policy in my father name policy also not written his existing disease details in both year policy .

I had forcefully clearly explain to (company employee) mr akash patel & he aware of existing disease of my father & Mother at time of purchased this both policy in year of 2019 .

Also Mr Aaksh patel ( Empl. of Chola MS ) fill up Proposal form its self and collect cheque and insured persons id card and collect details only from me .
He explained about proposal form at time of purchase of insurance. he asked that he will fill proposal form directly online site. and confirm that you received directly policy in your mail. Mr Aaksh was not show to proposal form after fill up .

May be this incident Existing disease are not mention in my both father and mother policy.

Also I have received a Browser of Details of Policy benefit and mention as same details as per above para. & Also mention as same uploaded in Bank of Baroda website. However my this Covid-19 claim is rejected / not approved on basis of only not updated Existing disease in record. its is valid as per rules ?. please suggest.

When I Inform to Mr Aakash Patel at time of Intimation for Hospitalization for Corona Positive treatment ( Covid-19) and he had also confirm that covid claim is granted in this Exclusive policy as per IRDA guidelines. And cashless not approved but reimbursement claim will be proceed.

Also after rejection my covid-19 claim I was taken clarification letter from my doctor / hospital and they was provided to me that & clarified that at time of admitted in hospital patient was symptoms Of corona positive and she was suffering in difficulty of breathing & O-two ( Oxygen ) level was low @86% with Fever and Cough.

Also Mention and clarified from doctor in this issued letter that Patient Not Suffering from Diabetic or Hyperattention & Not availed as same or related treatment at time of Hospitalize / admitted.

I Humble request to team that please help me and grant my this request and re look this process & provide claim reimbursement Amount as soon earlier. in this pandemic time.

Regards
Mainesh Patel
[protected]@yahoo.com
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