[Resolved]  Apollo Munich Health Insurance — REFUSAL OF CLAIM

Address:

West Bengal

I MET WITH AN INSURANCE AGENT FROM APPOLO MUNICH SOMETIME IN THE 2ND WEEK OF NOVEMEBER AND AFTER DISCUSSING WITH HIM I DECIDED TO SWITCH MY EXISTING HEALTH POLICY WITH ICICI LOMBORT TO APOLLO MUNCH AND SUBMIITED ALL THE REQUIRED DOCUMENTATION THAT WAS REQUESTED BY HIM ALONG WITH THE PREMIUM PAYMENT OF RS 14439/-

I WAS CONFIRMED THAT POLICY WILL BE IN CONTINUITY WITH MY PREVIOUS POLICY FROM ICICI LOMBART EXPIRING ON 23RD JANUARY 2011 AND THE NEW POLICY WILL BE EFFECTIVE FROM 24TH JANUARY 2011 IF I MADE THE PAYMENT OF THE 5TH JANUARY 2011 WHICH I DID (SEE COPY OF RECEIPT ATTACHED)

ON 5TH FEBRUARY 2011 I CALLED UP THE COMPANY REPRESENTATIVES FROM APOLLO MUNICH SEEKING ADVICE FOR HOSPITALIZATION OF MY WIFE LEELA MUNDHRA.I WAS ADVISED TO ADMIT HER BY MAKING REQUIRED PAYMENT WHICH SUBSEQUENTLY WILL BE RIMEIMBURSED TO ME.

WHEN I REAPPROCHED THE CUSTOMER CARE ON NOW TO FILE A CLAIM THEY INFORMED ME THAT I AM NOT ENTITILED FOR REIMBURSEMENT BECAUSE:
THE POLICY DOES NOT HAVE PORTABILITY CLAUSE AND EVENTUALLY IN ABSENCE OF THE CLAUSE ANY CLAIM CANNOT BE ENTERTAINED FOR THE FIRST 30 DAYS OF THE COMMENCEMENT OF THE POLICY.

MY HUMBLE SUBMISSON IN THE PRESENT CASE IS AS UNDER

I WAS HOLDING A POLICY PRIOR TO EXISTING ONE AND ACCORDINGLY PROCEEDED WITH THE PROCEDURE LIKE MAKING PREMIUM PAYMENT IN ADVANCE.HAVING THE POLICY SIMILAR AMOUNT AND TERMS AS PER ICICI LOMBORT.

IN CASE DOCUMENTS WERE NOT IN ORDER, THE COMPANY WOULD HAVE APPROACHED TO ME FOR CLAIFICATION/DOCUMENTATION BUT INSTEAD OF THAT CONVENIENTLY THEY HAVE DECIDED TO IGNORE THE PORTABILITY CLAUSE AND TREATED THE POLICY AS NEW.

YOU WILL APPRECIATE THAT SUCH UNILATERAL DECISION CAN NOT BE IMPOSED OR CAN NOT BE ACCEPTED AS AN EXCUSE TO DENY A CLAIM.

I have paid Rs.49800/-(Rs. Forty nine thousand eight hundred only) towards hospitalization
And seek your help to recover the same

(SHANKAR LAL MUNDHRA)