[Resolved]  Bajaj Allianz — TRAVEL HEALTH INSURANCE - FRAUD/CHEATING

I am a retired Defence Offcial and a senior citizen. At present, I am on vacation in USA. I had availed the Travel Health Insurance Policy from M/s Bajaj Allianz General Insurance Company Ltd., Pune vide Policy No OG[protected]-00012180 valid from 03-Dec-2009 to 31-May-2010 (name of the policy = Travel_Assist_Classic). I reached USA on 4-Dec-2009 along with my wife for whom also I had taken the policy from the above Insurance Company.

During 2nd week of Feb, I had certain serious health problems because of the extreme winter here viz., palpitation, dizziness, numbness in both the hands and shoulders. I was immediately taken to one of the hospitals in Clifton at New Jersey on an emergency condition as per the referral of the Alliance Partner of Bajaj Allianz in USA on 09th Feb 2010. After examining me, the Hospital prescribed two immediate tests viz., CAT scan of the brain and EKG (ECG) to arrive at a final diagnosis of the problems and also to ascertain whether any stroke threats exists or not. I was kept on temporary medication and the Hospital sent the message to Alliance Partner of the above Insurance Company to approve the above two tests on emergent basis. The Hospital had also stated that the symtoms do not pertain to any "pre-existing illness" and has to be evaluated after seeing the results of the above tests under emergency condition. They in turn referred the matter to Bajaj Allianz in India for approval. The total cost for these two tests works out to be USD 1275 (Cat scan USD 1200 + EKG USD 75)

But Bajaj Allianz did not give any cognisance to the report given by the Hospital and stated that they cannot approve these tests until they receive a final diagnosis???. They further stated that they can approve only USD 300 treating the above symptoms pertaining to "pre-existing illness" as against the medical opinion of the Hospital. Whereas, as per the terms of above policy, I am eligible for USD 50,000 (deductable USD 100) for medical expenses. In the meantime, their Alliance Partner in USA referred me to the same Hospital for EKG which was done on 2nd March. In the absence of the CAT scan report, the Hospital is not in a position to arrive at a final diagnosis of my present health problems, whereas BAJAJ ALLIANZ remains adamant NOT to approve the same stating that they want the final diagnosis/medical report which is only possible after completing the above test. as if they do not believe the medical opinion given by the Hospital where they had referred me for treatment, what a paradoxical and controversial situation?

Though I have been constantly corresponding with BAJAJ ALLIANZ, Pune for getting the above CAT scan approved, while I continue with the temporary medication for the problems mentioned, the above INSURANCE COMPANY is still delaying the matter on some or the other pretext like "final diagnosis" "pre-existing illness" "final medical reports" etc., They are really cheating me. I must state here that people who are intending to avail travel insurance from BAJAJ ALLIANZ must be CAREFUL, as once the policy premium amount is paid, they would not bother about our health problems especially when we are out of India.

I therefore submit this pathetic and unfortunate situation what I am presently facing in USA (especially being a senior citizen) before the Indian Consumer Forum for necessary intervention in the matter and getting necessary medical coverage/treatment from BAJAJ ALLIANZ on an emergent basis, as my present health continues to be as it was. My e-mail id is [protected]@GMAIL.COM. Address in USA : No 50 VAN RIPER AVENUE, RUTHERFORD, NEW JERSEY-07070, Phone No.[protected]