[Resolved]  Bajaj Allianz Life Insurance Company Limited — Claim against mediclaim policy

Address:

South West Delhi, Delhi

Respected Sir,

I, Dr. Rana mukhopadhyay, was the holder of mediclaim policy no.[protected]/27.10.2008 from Bajaj Allianz Life Insurance Company Ltd. During the month of September-2009, I had acute health problem and as per the advice of doctor, I had to do Stapler Heamaroidectomy surgery immediately. Accordingly I got admitted to Ayushman Hospital, Dwarka, New Delhi on 18.09.09. I got discharged on 19.09.09. At the time of admission, before the operation, when the hospital authority intimated the insurance company and asked them for the provision for cashless treatment. The company informed the hospital authority (through Fax) that in this case, there is no provision of cashless benefit, but the charges will be reimbursed and the patient had to pay the hospital bill during the treatment, because as per the company rules, the cash less facility is applicable in the second year of the policy. In the first week of october-09, I submitted the hospital bill to the insurance company through their agent Sh. Utpal Biswas(who mediated the mediclaim policy), at it’s Cannaught Place Branch. But the branch office holds my bill and claim application (including all original hospital receipts and reports) for almost one year. I have not been given the claim amount. When I approached the agent Mr. Utpal Biswas, during the end of the month of August 2010, he returned my bill and my application form to me on the first week of sept-2010.

The company even did not touch my application for further processing at all; moreover they never felt any importance to send me, any information during this period that they are unable to reimburse my claim. I am a Govt. employee and a member of GIS and I would have claimed from my office also. This company did not leave any option for me. When I asked the customer care executive, they said that it has been turned down by company as I did not deposit the renewal charges (second installment) for second year of the policy. They told me that it is a three year's policy and I paid only one installment and that is why, I am not eligible to claim. More over I come to know from there that, to get the claim, one has to deposit the installment of the next years. Though my policy and risk cover was valid till 25.10.2008.

I have been cheated by the company agent also. when the agent Utpal Biswas approached me for the mediclaim policy and I had started my first Bajaj Allainz Life Insurance's mediclaim policy(policy no[protected]/13.12.2007) for me and my wife, in December 2007. But, in the next year, in 2008, at the time of renewal, the company, instead of renewing the earlier policy, issued me another fresh three year's new mediclaim policy no,[protected]/18.10.2008. But when I claimed the reimbursement of my hospital bill, I had had been told that I had not renewed my policy and I am not eligible for the claim, because the claim for the treatment of my disease is applicable in second year of the policy.

Afterwards when I complained to the company, the company had told me to resubmit the claim application and accordingly I had submitted the claim application to their Dwarka, Sector-4 Branch, on 19.10.2010. But till the end of August 2011, I have not received any kind of information about my claim. Then I again requested the Customer Care of the company, regarding my case, through E-Mail. The company sends reply E Mail, as per the terms and condition; the claim for heamarroidectomy surgery is applicable only during the third year of the mediclaim policy. Is it can be a justified terms and condition, that, in spite of my acute disease and the advice of Surgeon for the immediate operation, I had to wait for three years, till the company will receive their third installment. More over, till date the company had not handed over my hospital bill and the medical reports.

Due to the negligence from the part of the company, I not only suffered the loss of the entire amount of my hospital charges but also faced lot of harassment and mental agony. I could not avail the facility of my G.I.S to reimburse my hospital bills. Because due to the negligence and non co operation of the company, I could not fulfill the official formalities, on proper time, to get my hospital charges reimbursed through GIS, from my Govt. Office. If they informed me clearly at the initial stage, I could have availed my GIS facility. From my view the Bajaj Allianz Life Insurance Company Ltd must be responsible for my entire suffering and the financial loss, and it is very much injustice for me and I have been cheated by the company.


Dr. Rana Mukhopadhyay,
C-14, Sarve Sanjhi Appt., Plot No.-8,
Sector-9, Dwarka,New Delhi-110077