[Resolved]  Happy Family Floater Policy / Oriental Insurance Company Ltd — DEFICIENCY IN VICE ASSURED

Subject: Deficiency in service promised by the insurance company
[--Policy No[protected]MDI[protected]/48/2010/20 Validity[protected]]

Dear Sir,
I was admitted in Sir Gangaram Hospital, New Delhi on 12.07.09 under diagnosis of Adeno Carcinoma Stomach and was operated by Dr S. Nundy on 13.07.09.I was discharged from hospital on 19.07.09.

The relevant papers of the policy handed over to me clearly underlines that I am entitled to a room rent of 1% of the sum assured that is Rs.5000 per day for Rs 5,00,000 policy bought by me. No where it was qualified that it is related to nature of disease etc. However in the authorization letter received from MD India, TPA of M/S Oriental Insurance co. ltd, a restriction of Rs. 1,750 per day on room rent was imposed (1% of the sum approved this illness) without any reason.

I had to pay Rs. 33,600 @ 4200 per day for 8 days to the Hospital against a reimbursement of Rs. 14,000 @ 1750 only from Insurance co. This is not in line with rate agreed at the time of renewal of the policy that is Rs.5000 per day.
Vide my letters dt 22 0709 n 28 08 09 I requested them to reimburse the difference that is Rs. 19,600 at the earliest, but the Insurance co failed to respond.

I feel this is a fit case of deficiency in promised services on the part of M/S THE ORIENTAL INSURANCE CO LTD.
I therefore request you to kindly help me and instruct the insurance co. to pay me the balance amount without further delay.

A summary detail of the case is given below for your ready reference.

1. Policy No MDI[protected]/48/2010/20
2. Validity of the policy [protected]
3. Insured person Ravi Shankar Behera
4. Insurance company M/S The Oriental Insurance co ltd
5. H/O A-25/27 Asaf Ali Road,New Delhi-110002 tel phone [protected]

No. of days Hospitalisation Room Rent entitlement as per policy Actual charge by hospital Room rent paid by insurance company Amount paid by the insured Due for reimbursement
by the insurance company
8 8 @ Rs.5000=
Rs. 40000 8 @ Rs. 4200= Rs.33,600 8 @ Rs. 1750 = Rs.14000 Rs 33600-Rs. 14000=Rs 19600 Rs. 19600


Yours sincerely


Ravi Shankar Behera/Shipra Saxena (spouse)
B-65, 5th Floor
National CGHS
Sector 3
Plot 4, Dwarka
New Delhi – 110 078
+91 11 [protected]
[protected]