[Resolved]  Apollo Munich Health Insurance Company Limited — Case No. 270,214 ( Policy No. [protected] )

Address:

South Delhi, Delhi

Hi,

I had filed one claim of my sister Kamini Aggarwal at your FHPL, office in Gurgaon. The details are as below:

Name of Insured person: Kamini Aggarwal
Name of Insured: Apollo Munich : 110102 : Noida : SO
Claimed amount: 266944/-
Claimed for: AVN Bilateral Hip
Provider: SitaRam Bhartia Institute of science & research

The said claim got rejected vide Claim ID - 55709 as pre existing disease stated by Apollo Munich health Insurance co.

Facts:

• The policy start date is 23rd Feb,11
• The patient had come to know about this disease in September,2011 when she had acute pain in her left leg
• Had we know earlier we would have not waited for six months to get her operated & let her bear this pain.
• Upon consultation with the doctor we got it operated in October,2011
• The doctor tried for cashless also but the same got rejected by Apollo saying that the patient can claim as reimbursement later.
• We were suggested to pay in advance for the entire expense & later file for the claim
• If that was the case then we should have got her treated in some govt. hospital as she is not that financially sound to bear such a huge expense.

Than again I referred my case to their grievance cell & again got a rejection e mail on 12th Dec, 2011. Post that I got back to TPA at the hospital on 16th jan,2012 stated the reason of rejection but did not receive any reply from them. I even followed up with TPA till 18th Feb,2012 but went in vain.

Than I referred my case to the Ombudsperson on 15th March,2012 detailing out the incident. Since then I have been following up with the Ombudsperson but did not receive any justice. Though exchanged couple of communication with them but fruitless.

My submission here is that why do these companies harras the customers & make false promises. It seems that they are trying to escape of their responsibility. The plea that they are taking is that it is a pre disease existing for more than two years whereas I kept saying that how come a person afford to have pain for two years without any treatment. That is all.

Moreover, we have paid the premium for two years now. Had we intended to any wilful act, we would not have paid the premium in the second year.

I await justice & reimbursement of my claim of 266944/- along with compensation of this delay & mental harrasment.

Best Regards,
Manoj Goel
B/O Kamini Agarwal
[protected]